Systematic Reviews最新文献

Background: Physical therapy interventions play a crucial role in the daily care of patients recovering from severe stroke. However, the efficacy of these interventions and associated modalities, including duration, intensity, and frequency, have not been fully elucidated. In 2020, a systematic review reported the beneficial effects of physical therapy for patients with severe stroke but did not assess therapeutic modalities. We aim to update the current evidence on the effects of physical therapy interventions and their modalities in relation to the recovery phase in people with severe stroke in a hospital or inpatient rehabilitation facility.

Methods: We searched CENTRAL, MEDLINE, Web of Science, and three other relevant databases between December 2018 and March 2021 and updated the search between April 2021 and March 2023.

Clinicaltrials: gov and ICTRP for searching trial registries helped to identify ongoing RCTs since 2023. We included individual and cluster randomized controlled trials in the English and German languages that compared physical therapy interventions to similar or other interventions, usual care, or no intervention in a hospital or rehabilitation inpatient setting. We screened the studies from this recent review for eligibility criteria, especially according to the setting. Critical appraisal was performed according to the Cochrane risk-of-bias tool 2.0. The data were synthesized narratively.

Results: The update identified 15 new studies, cumulating in a total of 30 studies (n = 2545 participants) meeting the eligibility criteria. These studies reported 54 outcomes and 20 physical therapy interventions. Two studies included participants during the hyperacute phase, 4 during the acute phase,18 during the early subacute phase, and 3 in the late subacute phase. Three studies started in the chronic phase. Summarised evidence has revealed an uncertain effect of physical therapy on patient outcomes (with moderate to low-quality evidence). Most studies showed a high risk of bias and did not reach the optimal sample size. Little was stated about the standard care and their therapy modalities.

Discussion: There is conflicting evidence for the effectiveness of physical therapy interventions in patients with severe stroke. There is a need for additional high-quality studies that also systematically report therapeutic modalities from a multidimensional perspective in motor stroke recovery. Due to the high risk of bias and the generally small sample size of the included studies, the generalizability of the findings to large and heterogeneous volumes of outcome data is limited.

Systematic review registration: PROSPERO CRD42021244285.

Artificial Intelligence (AI) is transforming systematic reviews (SRs) in health research by automating processes such as study screening, data extraction, and quality assessment. This perspective highlights recent advancements in AI tools that enhance efficiency and accuracy in SRs. It discusses the benefits, challenges, and future directions of AI integration, emphasising the need for human oversight to ensure the reliability of AI outputs in evidence synthesis and decision-making in healthcare.

Background: Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care.

Methods: This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O'Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review's aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR).

Conclusion: This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms.

Systematic review registration: Not applicable.

Following up the previously published systematic review on the same topic and realizing that new studies and evidence had emerged on the matter, we conducted an update on the same research terms. With the objective of updating the information relating environmental risk factors on neurodegenerative diseases and the geographic approaches used to address them, we searched PubMed, Web of Science and Scopus for all scientific studies considering the following three domains: neurodegenerative disease, environmental atmospheric factor and geographical analysis, using the same keywords as in the previously published systematic review. From February 2020 to February 2023, 35 papers were included versus 34 in the previous period, with dementia (including Alzheimer's disease) being the most focused disease (60.0%) in this update, opposed to multiple sclerosis on the last review (55.9%). Also, environmental pollutants such as PM_2.5 and NO₂ have gained prominence, being represented in 65.7% and 42.9% of the new studies, opposed to 9.8% and 12.2% in the previous review, compared to environmental factors such as sun exposure (5.7% in the update vs 15.9% in the original). The mostly used geographic approach remained the patient's residence (82.9% in the update vs 21.2% in the original and 62.3% in total), and remote sensing was used in 45.7% of the new studies versus 19.7% in the original review, with 42.0% of studies using it globally, being the second most common approach, usually to compute the environmental variable. This review has been registered in PROSPERO with the number CRD42020196188.

Background: Adult day programs aim to facilitate aging in place by supporting the health and well-being of persons with dementia and providing respite to their caregivers. However, studies on the effects of day programs are inconclusive, and we especially lack insights into the context conditions and mechanisms of day programs that may produce different outcomes for different groups of persons with dementia and their caregivers. Our objective was to conduct a realist review, synthesizing research on day programs to develop program theories explaining how and why day programs do or do not produce positive or negative outcomes for different groups of persons with dementia, and caregivers.

Methods: We identified 14 literature reviews (including 329 references published between 1975 and 2021) on adult day programs. From this initial pool of studies, we will include those that focused on day program attendees with dementia or meaningful cognitive impairment, and/or their caregivers, and that report how day program contexts (C) and mechanisms (M) bring about outcomes (O) for attendees and caregivers. We will extract CMO statements (i.e., narratives that explain how and why day programs do or do not bring about certain outcomes for whom and under what circumstances). Using additional focused searches, citation mapping, citation tracking, and discussions with our researcher and expert team members, we will identify additional references. CMO statements will be synthesized, transformed into hypotheses, and linked and visualized to form program theories. Using focus groups and the James Lind Alliance Priority Setting Partnership method, we will discuss and prioritize our CMO statements and refine our program theories with 32 experts (older adults, caregivers, Alzheimer societies, caregiver organizations, day program staff and managers, and health system and policy decision makers).

Discussion: By identifying essential elements and processes of day programs and related knowledge gaps, this study will generate much-needed knowledge to leverage the full potential of day programs so they can provide appropriate care, preventing premature institutionalization, and unnecessary acute and primary care use. This will ultimately improve the quality of life of persons with dementia and their caregivers, alleviate caregiver burden, and reduce social costs.

Systematic review registration: PROSPERO CRD42024504030.

Background: As a driver of racial and health inequities, racism is deeply ingrained in the interconnected systems that affect health and well-being. Currently, no common frame is employed across researchers, interventionists, and funders to design, implement, and evaluate comprehensive interventions to address racism. Consequently, there is a need to examine the characteristics of interventions implemented in the United States that address racism across social and structural determinants of health and socio-ecological levels. Additionally, we utilized a Health Equity Action Research (HEART) framework to assess how interventions integrate equity principles.

Methods: This scoping review examined the characteristics of multi-level interventions that addressed racism and appraised the interventions using a Health Equity Action Research frame. A comprehensive search strategy was conducted across nine electronic databases between 24 October 2022 through 15 November 2022. Records were included if they were available in English, discussed or evaluated a multi-level intervention or program conducted in the United States, and discussed or evaluated the intervention or program regarding the health and well-being of racialized and ethnically minoritized groups.

Results: A total of 13,391 records were identified, of which 91 met the eligibility criteria and were included in the analysis. Most records reported the racialized group impacted by an intervention, of which the majority were racialized as African American or Black (n = 42) and Hispanic or Latino/a/x (n = 18). Eighty-one (89%) of interventions reported health outcomes and concentrated on the individual level. Most funders reported across the records, and 86 (51%) were a federal agency or department. A further 43 (25%) were private foundations, 12 (7%) were nonprofit organizations, 10 (6%) were private universities, and 4 (2%) were public universities. Regarding alignment with the HEART framework, 14% of interventions reported a mixed-methods approach, 45% reported community engagement, and less than 1% reported researcher self-reflection.

Conclusions: Most interventions prioritized people who are racialized as Black and report health outcomes. Since intervention designs, objectives, and methodological approaches vary, no standard frame defines racism and health equity. Applying the HEART framework offers a standard approach for interventionists and researchers to examine power, integrate community voice, and self-reflect to advance health equity.

Background: Interventions that leverage implicit motives - affect-based, non-conscious motivational dispositions - may increase physical activity by making physical activity more pleasurable. However, there is no evidence synthesis of the empirical data linking the major implicit motives (achievement, affiliation, and power motives) and physical activity. We aimed to close this research gap.

Methods: Following a systematic literature search in the PsycInfo, PubMed, and Web of Science databases until August 2024, we performed a scoping review. We included German- or English-language publications in peer-reviewed journals or books that followed an observational or intervention study design. Studies had to link ≥ 1 major implicit motive measured via a well-established method to physical activity behavior. We critically appraised the methodological quality of the included studies using an adaptation of the JBI critical appraisal checklist for analytical cross-sectional studies and synthesized the evidence qualitatively.

Results: Out of 1047 potentially relevant records, five publications (seven studies, N = 550) were included. All eligible studies were observational (six cross-sectional, one prospective longitudinal). The achievement motive was researched the most. The data indicated a relatively consistent positive association between physical activity and the achievement motive, particularly in athletes and in sports-specific settings. The associations with the affiliation and power motives were more mixed. Most studies were conducted in sports-specific settings. All studies elicited methodological concerns, to varying degrees.

Conclusions: The available data indicate a positive association between achievement motive strength and physical activity. However, important limitations, especially the lack of intervention studies and the use of non-gold standard assessment methods, limit the confidence in the findings. More, methodologically sound research is needed to better understand the link between implicit motives and physical activity, especially in the general population.

Systematic review registration: PROSPERO CRD42023392198.

Background: In recent decades, the literature on global partnerships in nursing and midwifery education, to enhance the quality of education and produce competent graduates in the labor market, is on the rise in Africa. However, there is a gap regarding the best practices and barriers in the African context. This systematic scoping review aims to map the evidence on academic partnerships in transforming nursing and midwifery education in Africa.

Methods: The review will be guided by Arksey and O'Malley's methodology framework through five stages: (1) Identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collecting, summarizing, and reporting the results. A search will be conducted with the use of the following electronic databases: Cumulative Index to Nursing and Applied Health Literature (CINAHL), PubMed, ScienceDirect, and Google Scholar. Additional gray literature will be searched via the World Health Organization's website to locate relevant policies and guidelines. The search will be limited to work published in English from 2014 to 2023. All located resources will be exported to EndNote X8. All duplicates will be removed during when the abstracts are screened. Two independent reviewers will screen and extract the full text of the selected articles. Thematic analysis will be used to analyze data from this systematic scoping review.

Discussion: Mapping the evidence on global partnerships in transforming nursing and midwifery education in Africa will outline the best practices and preferences for sustainable collaboration. The review will also highlight knowledge gaps and limitations that could inform future research projects.

Systematic review registration: https://osf.io/h83cy.

Background: The association between cancer and multiple sclerosis has long been investigated. Several studies and reviews have examined the risk of cancer among patients with multiple sclerosis treated with disease-modifying therapies (DMTs) but with conflicting results. This study will aim to investigate the association between DMTs for multiple sclerosis and subsequent cancer risk using research synthesis methods.

Methods/design: We designed and registered a study protocol for a systematic review and meta-analysis. We will include randomised and non-randomised trials, prospective or retrospective cohort studies, and case-control studies of treatment with DMTs compared with placebo, no treatment, or another active agent. The primary outcome will be the risk of cancer (all-malignant neoplasms) in association with the exposure of DMTs. Secondary outcomes will include site-specific cancers (e.g. breast cancer). Literature searches will be conducted in multiple electronic databases (from their inception onwards), including the following: PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). Two researchers will screen all citations, full-text articles, and abstract data independently. The risk of bias (quality) of individual studies will be appraised using an appropriate tool. If feasible, we will use a two-stage approach to evidence synthesis: (1) Peto's method for meta-analysis of data from randomised trials alone; and (2) Random-effects model for meta-analysis adding data from non-randomised studies. We will calculate odds ratios and their associated 95% confidence intervals. Potential sources of heterogeneity will be explored in additional analyses (e.g. subgroups considering different DMTs individually, mechanism of action, type of control, length of follow-up, mode of treatment).

Discussion: This systematic review and meta-analysis of randomised and non-randomised studies will provide an updated synthesis of the risk of cancer associated with DMTs for adult patients with multiple sclerosis. This study will also examine some factors that may explain potential variations across studies. The findings will be published in a peer-reviewed journal.

Systematic review registration: Open Science Framework ( https://osf.io/v4sez ).

Background: The standard approach to local inconsistency assessment typically relies on testing the conflict between the direct and indirect evidence in selected treatment comparisons. However, statistical tests for inconsistency have low power and are subject to misinterpreting a p-value above the significance threshold as evidence of consistency.

Methods: We propose a simple framework to interpret local inconsistency based on the average Kullback-Leibler divergence (KLD) from approximating the direct with the corresponding indirect estimate and vice versa. Our framework uses directly the mean and standard error (or posterior mean and standard deviation) of the direct and indirect estimates obtained from a local inconsistency method to calculate the average KLD measure for selected comparisons. The average KLD values are compared with a semi-objective threshold to judge the inconsistency as acceptably low or material. We exemplify our novel interpretation approach using three networks with multiple treatments and multi-arm studies.

Results: Almost all selected comparisons in the networks were not associated with statistically significant inconsistency at a significance level of 5%. The proposed interpretation framework indicated 14%, 66%, and 75% of the selected comparisons with an acceptably low inconsistency in the corresponding networks. Overall, information loss was more notable when approximating the posterior density of the indirect estimates with that of the direct estimates, attributed to indirect estimates being more imprecise.

Conclusions: Using the concept of information loss between two distributions alongside a semi-objectively defined threshold helped distinguish target comparisons with acceptably low inconsistency from those with material inconsistency when statistical tests for inconsistency were inconclusive.