Systematic Reviews最新文献

Background: Both attention-deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are complicated illnesses that sometimes co-occur in children and adults with significant negative influence on a person's life and general well-being.

Aim: This study aims to conduct a systematic review that investigates the comorbidity of PTSD and ADHD in the adult population.

Methods: A comprehensive search was conducted across five electronic databases (PsycNET, Cochrane, PubMed, Google Scholar, and ClinicalTrials.gov) between October 5 and 20, 2023, using predefined keywords including "ADHD," "PTSD," and "comorbidity." Studies were included if they involved adult participants (≥ 18 years) with both ADHD and PTSD diagnoses. Two independent reviewers conducted screening and data extraction. No meta-analysis was performed due to heterogeneity in study designs. The results were synthesized qualitatively.

Results: Out of 818 identified studies, 21 met the inclusion criteria. Studies reported an increased risk of developing PTSD in individuals with ADHD, with the prevalence of comorbidity ranging between 28 and 36%. ADHD in PTSD patients was associated with greater psychosocial impairment, more severe PTSD symptoms, and functional difficulties. Treatment approaches, including pharmacotherapy (atomoxetine, Vyvanse) and mindfulness training, showed potential benefits for managing comorbid symptoms.

Conclusions: ADHD and PTSD commonly co-occur in adults, leading to more severe clinical outcomes. Early diagnosis and effective treatment of ADHD may reduce the risk of developing PTSD. Further research is needed to explore the underlying mechanisms and optimal treatment strategies for individuals with ADHD/PTSD comorbidity.

Systematic review registration: PROSPERO CRD42023479631.

Background: Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) are at high risk of thrombosis. However, bleeding-related complications during antithrombotic therapy remain a major barrier to effective treatment and can often lead to adverse outcomes. This meta-analysis aimed to determine the efficacy and safety of bivalirudin and heparin in patients with ACS after PCI.

Methods: Randomized controlled trials (RCTs) on the efficacy and safety of bivalirudin versus heparin in patients with ACS after PCI were identified from the PubMed, Embase, Cochrane Library, CBM, CNKI, WanFang, and VIP database until August 2024. The outcomes included all-cause mortality, major adverse cardiovascular events (MACEs), incidence of recurrent myocardial infarction, stent thrombosis, short-term bleeding, revascularization, and retransfusion. Meta-analysis was performed using RevMan 5.3 and Stata 12.0 softwares. The included studies were assessed for risk of bias using the Cochrane risk-of-bias assessment tool.

Results: A total of 70,199 patients from 27 randomized controlled trials (RCTs) were analyzed in this review. There were no significant differences between the bivalirudin and heparin groups in terms of all-cause mortality, major adverse cardiovascular events (MACEs), recurrent myocardial infarction, stent thrombosis within 30 days, or subacute stent thrombosis. Specifically, the incidence of short-term bleeding (P = 0.001) and retransfusion (P = 0.001) was significantly lower in the bivalirudin group compared to the heparin group. Conversely, the incidence of acute stent thrombosis (P < 0.0001) and revascularization (P = 0.009) was significantly higher in the bivalirudin group.

Conclusions: Compared with heparin, bivalirudin has definite anticoagulant effect in patients with acute myocardial infarction after PCI, and the risk of bleeding and the incidence of retransfusion were lower in the bivalirudin group. This review helps doctors in PCI management choose bivalirudin or heparin more precisely based on patients' conditions for better treatment and fewer adverse events.

Background: In the past decade, there has been a significant advancement in targeted therapy and immunotherapy, leading to the discovery of new drugs and changes in the treatment approach for patients with HER2-positive gastric cancer. Although several drugs are available for treating these patients, there is still no consensus on their selection, and there has been limited direct or indirect comparison among them.

Objective: To address this gap, a network meta-analysis was conducted to assess the efficacy and safety of different drugs used in the treatment of HER2-positive gastric cancer.

Methods: By searching through databases such as PubMed, Embase, Web of Science, and Cochrane Library, we identified 16 randomized controlled trials that involved a total of 4485 patients and utilized 9 different intervention measures.

Results: Based on the current evidence, compared with chemotherapy alone, the hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS) in gastric cancer patients treated with nivolumab were [hazard ratio (HR): 2.61 95%confidence interval (CI) (1.51, 4.51)] and [hazard ratio (HR): 2.01 95% confidence interval (CI) (1.18, 3.42)], respectively. Compared with chemotherapy alone, the hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS) in gastric cancer patients treated with trastuzumab deruxtecan were [hazard ratio (HR): 1.7 95% confidence interval (CI) (1.13, 2.56)] and [hazard ratio (HR): 2.13 95% confidence interval (CI) (1.42, 3.22)], respectively. It is suggested that nivolumab and trastuzumab deruxtecan can effectively prolong overall survival (OS) and progression-free survival(PFS) in patients with HER2-positive gastric cancer, while also reducing the risk of adverse events to some extent. Therefore, these two regimens, nivolumab and trastuzumab deruxtecan, are considered to be effective and safe options for the treatment of patients with HER2-positive gastric cancer.

Conclusions: In previous studies, trastuzumab-based chemotherapy has been a common treatment for HER2-positive gastric cancer. To a certain extent, our study provides a reliable direction for future treatment options for HER2-positive gastric cancer.

Systematic review registration: PROSPERO CRD42023420941.

Objective: To investigate the decision-making process of women returning to work after maternity leave or parental leave and explore the influence of cultural norms and societal expectations on their choices. Additionally, we seek to understand the lived experiences of the women in this context.

Introduction: Cultural norms and societal expectations significantly affect women's decisions regarding post-childbirth employment. However, a comprehensive understanding of these influences on women's experiences returning to work after parental leave is lacking.

Inclusion criteria: We will include qualitative studies examining women's decision-making processes and experiences of returning to work after parental leave, with a focus on the influence of cultural norms and societal expectations. Studies from diverse cultural and geographical settings, including peer-reviewed journals and gray literature, will be considered without restrictions on publication date or language.

Methods: The review will adhere to the JBI approach for qualitative systematic reviews. Major academic databases and search engines, such as CINAHL, PubMed, and Google Scholar, will be used. Study selection will involve screening titles and abstracts for relevance, followed by a full-text assessment against inclusion criteria by two independent reviewers. Critical appraisal using the JBI Critical Appraisal Checklist for Qualitative Research will evaluate study rigor. Data extraction will be conducted by two independent reviewers, using the standardized JBI data extraction tool within JBI SUMARI, to identify key themes and findings related to the women's decision-making process and lived experiences of returning to work after parental leave. The meta-aggregation approach will be utilized to synthesize findings, with confidence assessed through study quality and consistency. Any methodological deviations will be documented. Findings will be graded using the ConQual approach and presented in a summary of findings table.

Discussion: By synthesizing data from different cultural contexts, this review will help bridge the gap in understanding how these factors influence women's choices. Rigor in the review will be ensured through the process of study selection, appraisal, and synthesis using the JBI approach. The findings will provide challenges faced by women and inform policies to help support their transition back to work.

Systematic review registration: PROSPERO CRD42024546633.

Background: The COVID-19 pandemic has resulted in a critical shortage of respiratory ventilators, highlighting the urgent need to explore alternative treatment options for patients with acute respiratory distress syndrome (ARDS) caused by respiratory viruses, as an alternative to invasive mechanical ventilation (IMV) in future pandemics.

Objectives: The objective of this study was to assess the effectiveness of alternative noninvasive oxygenation and ventilation strategies in comparison to invasive mechanical ventilation (IMV) in patients with virus-induced acute respiratory failure (ARF). The primary outcome was the all-cause ICU mortality rate.

Methods: A systematic review was conducted following the Cochrane guidelines and PRISMA reporting guidelines. The search encompassed databases such as Medline, Cochrane CENTRAL, and Embase to identify relevant indexed literature. Additionally, gray literature was included by consulting regulatory agencies. The included studies compared various oxygenation and ventilatory alternatives, such as high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), or noninvasive mechanical ventilation (NIMV) with IMV. An exploratory meta-analysis was performed by calculating the risk ratio (RR) by random effects and meta-regression to explore possible sources of heterogeneity and to compare ventilatory alternatives against IMV to reduce mortality, length of stay (LOS) days in ICU, nosocomial infection, and barotrauma.

Results: A total of forty-seven studies were included in this systematic review. NIMV had an RR of 0.70 (0.58-0.85), HFNC had an RR of 0.54 (0.42-0.71), and CPAP had an RR of 0.80 (0.71-0.90), with meta-regression models that reduced heterogeneity to 0%. For LOS days in ICU, NIMV had 0.38 (- 0.69: - 0.08) lower days and HFNC 0.29 (- 0.64: 0.06) lower days with meta-regression models that reduction heterogeneity to 0% for HFNC and 50% for NIMV. Not enough studies reported nosocomial infection or barotrauma to evaluate them in a meta-analysis. The overall quality of evidence, as assessed by GRADE evaluation, was determined to be from very low to medium certainty depending on the ventilatory strategy and outcome.

Conclusions: The findings of this systematic review support the use of alternative noninvasive oxygenation and ventilation strategies as viable alternatives to conventional respiratory ventilation for managing viral-induced ARF. Although it is essential to interpret these findings with caution given the overall low to medium certainty of the evidence, the integration of these modalities as part of the management strategies of these patients could help reduce the utilization of ICU beds, invasive ventilators, and costs in both developed and developing countries.

Background: Cardiac autonomic neuropathy (CAN) is an underdiagnosed complication of type 2 diabetes mellitus (T2DM) and is associated with cardiovascular morbidity and mortality. Cardiac autonomic reflex tests (CARTs) are the gold standard; they are non-invasive and clinically feasible for screening CAN. The objective of the present meta-analysis was to examine exercise's effect on cardiac autonomic function using CARTs in T2DM.

Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis Checklist (PRISMA) was used. Electronic databases were systematically used to retrieve relevant studies after title and abstract screening. Studies utilizing exercise training with cardiac autonomic function (CARTs) outcomes in individuals with type 2 diabetes mellitus were included. The meta-analysis was conducted using RevMan 5.4.1, using the random effects model, and appropriate tests for heterogeneity. The Cohrane ROB-2 tool was used for randomized controlled trials (RCTs) and the ROBINS-I tool for non-RCT for risk of bias assessment were used.

Results: Three studies were included (two for meta-analysis), considering the outcome of the E:I ratio, 30:15 ratio, and Valsalva ratio. The studies did not show any influence on the E:I and 30:15 ratio in the pooled analysis with a low risk of ineffectiveness for the exercise intervention. Exercise training significantly affected the Valsalva ratio. A different type of exercise intervention was utilized in all three studies. There was a low to moderate certainty for the evidence.

Conclusion: The results indicate that further robust and high-quality randomized controlled trials utilizing cardiac autonomic reflex tests (which have clinical and physiological relevance) in type 2 diabetes mellitus are required for drawing conclusions.

Systematic review registration: PROSPERO CRD42023445561.