Systematic Reviews最新文献

Background: Research demonstrates that exercise training is both safe and beneficial for individuals with multiple sclerosis (MS). This is a timely opportunity to update the guidelines for exercise training in MS, as the number of randomized controlled trials (RCTs) examining the effects of exercise training on a range of functional and biomedical outcomes among adults with MS has increased substantially in the past decade. The evidence for updating the guidelines should be gathered through rigorous methodology, thereby ensuring a comprehensive analysis. The objective of this systematic review of the literature will be to evaluate the type and dose of exercise training necessary to improve fitness, biomarkers of health and disease, physical and cognitive functions, symptoms of MS, quality of life, and/or participation in activities of daily life among adults with MS presenting with mild, moderate, or severe disability.

Methods: This protocol for a systematic review follows the PRISMA-P guidelines and was registered on PROSPERO. RCTs of chronic exercise interventions for people with MS will be included. Studies will be excluded if they focus on other neurological conditions, interventions, or if their data are solely qualitative. A systematic and comprehensive search will be conducted across eight electronic bibliographic databases. Retrieved references will be screened by two authors. Data will be extracted into piloted tables and synthesized qualitatively. Methodological quality of the included studies will be determined using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX), and risk of bias will be assessed through the revised Cochrane risk-of-bias tool for RCTs (RoB 2). Finally, the certainty of evidence provided for the outcomes of interest across studies will be evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines.

Discussion: The evidence gathered and analyzed through this review will be crucial for our next step of updating the exercise guidelines for MS. These updated guidelines will provide people with MS, their families and/or their caregivers, and health care professionals and MS services organizations or advocates, with clear information to promote exercise training among patients with MS. This will subsequently facilitate implementation of exercise training programs into MS care.

Systematic review registration: PROSPERO CRD42025628825.

Background: Dexmedetomidine and lidocaine are commonly used adjuvants in postoperative pain management; however, their comparative efficacy is unclear. This meta-analysis compared the effects of intravenous dexmedetomidine and lidocaine on postoperative analgesia and recovery.

Methods: Cochrane Library, Medline, Embase, and Google Scholar were searched from their inception to July 1, 2024, to identify relevant randomized controlled trials (RCTs) comparing intravenous dexmedetomidine and lidocaine in adult patients undergoing non-cardiac surgery under general anesthesia. The primary outcomes were the postoperative pain score at 24 h and postoperative opioid consumption. The secondary outcomes included early postoperative pain scores, intraoperative opioid/anesthetic requirements, hemodynamic parameters, recovery characteristics, and inflammatory markers.

Results: Twenty-four studies (1,697 patients) were included. There was no significant difference between dexmedetomidine and lidocaine in terms of pain scores at 24 h (mean difference [MD]: 0.01, p = 0.88) or overall postoperative opioid consumption (standardized MD[SMD]: -0.51, p = 0.06). However, dexmedetomidine was associated with lower pain scores at 2-4 h postoperatively (MD:-0.41, p = 0.02), reduced intraoperative anesthetic agent requirements (SMD:-1.1, p = 0.004), a longer time to rescue analgesic (MD: -29.93 min, p < 0.00001), and improved quality of recovery scores (SMD: 1.72, p = 0.01). Dexmedetomidine resulted in lower heart rate and blood pressure compared to lidocaine, without differences in other recovery characteristics and inflammation.

Conclusion: Both dexmedetomidine and lidocaine are effective adjuvants for improving postoperative outcomes. Nevertheless, dexmedetomidine has shown advantages in terms of early pain control, reduced anesthetic requirements, and improved quality of recovery. The choice of these agents should be based on individual patient factors and specific surgical procedures.

Background: Hypertension is disproportionately prevalent in African women (48% prevalence rate vs. 34% in men) and poorly controlled (13% control rate in sub-Saharan Africa vs. 23% globally). Digital health platforms (e.g., mHealth, telehealth, telemedicine) have the potential to improve access to hypertension care in Africa, which has a mostly rural population (51.2%). However, gender experiences, needs, and barriers to care are not well researched. A scoping review is a suitable approach to conduct an initial mapping of disparate evidence and identify gaps related to digital health interventions for hypertension in African women. The scoping review can inform future research and policy.

Methods: The protocol has been registered on Open Science Framework and adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension (PRISMA-ScR) and JBI standards. All studies from 2010 through 2025 on women 18 years and older in 54 African nations will be included and will represent significant data on digital health programs. Two reviewers will conduct a faceted search of keywords such as "Hypertension," "Women," "Africa," and "Digital Health" in various databases, grey literature, and resources such as the X platform. Data will be extracted using a standardized form, with quality assessment following Cochrane RoB2 and Newcastle-Ottawa Scale where applicable. The results will be presented by research question (such as barriers and effectiveness) and region, setting, and design of study and will be intended for sharing with scientific and public communities.

Discussion: This review will map digital health interventions for hypertension management, systematically examining gender-based barriers and socioeconomic factors. Quantitative outcomes (e.g., blood pressure control rates, treatment adherence) and qualitative findings (e.g., themes of user acceptability, trust in digital health platforms) will be synthesized to identify evidence gaps and inform the development of equitable, gender-responsive digital health tools and policies. Study heterogeneity is a limitation, mitigated by a rigorous search.

Conclusion: This protocol ensures transparent reporting, with amendments documented in OSF. Findings will guide stakeholders to improve hypertension control.

Evidence synthesis (ES) involves rigorous, reproducible methodologies, which are increasingly being presented as 'Living' systematic reviews. As such, ES are critical to evidence-informed decision-making processes, such as the development, implementation, evaluation and monitoring of health technology assessments, practice guidelines and policies. However, the ES process is time-intensive, typically requiring months or years and extensive manual effort. Technological advancements, particularly artificial intelligence (AI), offer opportunities to automate various ES steps, potentially increasing efficiency and reducing costs. AI tools and platforms, including large language models (LLMs), facilitate faster ES through advanced natural language processing (NLP) capabilities. Despite their potential, AI tools have limitations, including risks of automation bias and lack of true semantic understanding, requiring careful evaluation to ensure trustworthiness. We conducted the first scoping review to update and map all data science tools, including LLMs, which are either being developed and/or deployed to optimise ES steps and assess their impact in both low- and middle-income countries (LMICs) and high-income countries (HICs). Our scoping review identified 137 studies and 388 of such AI tools and platforms to respond to the World Health Organization's call for safe and ethical AI in health, documenting the current landscape to identify barriers and facilitators to equitable and sustainable access for glocal researchers. We further outline three recommendations: (1) promote collaborative AI platforms ensuring equity of access to include gap regions identified (Latin America, Africa, Middle East), (2) establish evaluation standards for methods testing and reporting, and (3) emphasise human input and multidisciplinary capacity building for developing and implementing AI tools in ES.

Background: Amphetamine-type stimulant use disorder (ATSUD) contributes to the global burden of disease, notably due to its social, physical, and psychological consequences. Psychiatric disorders are frequently observed among people with ATSUD, while we still do not know their exact global prevalence because of multiple sources of heterogeneity. Here, we propose a protocol for a systematic review and a series of meta-analyses to describe the global prevalence of psychiatric disorders observed in individuals living with ATSUD.

Methods: A pilot systematic search was conducted to develop a protocol for a systematic review and a series of meta-analyses. A final systematic search will be conducted in MEDLINE, Embase, PsycINFO, and CINAHL to retrieve, among articles indexed since 1999, prevalence estimates of psychiatric disorders within individuals living with ATSUD. The final systematic review will support multiple separate meta-analyses, each investigating one or more concomitant psychiatric disorders. Diagnosis proportions of psychiatric disorders will be obtained using DSM-IV, DSM-5, ICD-10, and ICD-11 criteria or validated psychometric methods. Risk of bias will be assessed using the prevalence studies checklist from the Joanna Briggs Institute's critical appraisal tool. Proportions of diagnoses will be pooled using random-effect meta-analysis for each psychiatric disorder. Heterogeneity linked to methodological, sociodemographic, and spatiotemporal characteristics will be assessed using subgroup analyses and meta-regressions.

Discussion: The pilot search allowed the identification of 10 psychiatric disorders associated with ATSUD and refinement of the final search and meta-analysis protocol. This project will provide one of the first global and comprehensive syntheses of psychiatric disorders' prevalence in people with ATSUD to date, a set of evidence that will contribute to a more adapted and equitable public health response to this epidemic.

Systematic review registration: Open Science Framework Repository ( https://doi.org/10.17605/OSF.IO/FKDJY ).

Background: Although diabetes mellitus is an established risk factor for acute myocardial infarction (AMI), epidemiological studies showed wide variations in the incidence of AMI in people with diabetes and inconsistent time trends. The objectives of the present systematic review were as follows: (i) to analyze the age-sex-adjusted incidence of both non-fatal and fatal AMI in people with diabetes compared to those without diabetes, (ii) to investigate corresponding time trends, and (iii) to identify sex differences.

Methods: A systematic literature search was performed in the literature databases MEDLINE, Embase, and LILACS until July 19, 2023, to identify population-based studies reporting the incidence of AMI in people with diabetes compared to those without diabetes according to our predefined inclusion criteria.

Results: In total, 28 population-based cohort studies were included in this review. In women with diabetes, the incidence of AMI ranged from 102 to 690 per 100,000 person-years, and in men with diabetes from 206 to 1630. Estimates comparing people with and without diabetes ranged from 1.55 (95% CI 1.44-1.67) to 14.37 (8.43-24.47) in women and from 1.33 (1.18-1.51) to 4.17 (2.72-6.37) in men. Over the past four decades, the incidence of AMI declined in almost all studies in people without diabetes, but only in half of the studies in people with diabetes. There was considerable heterogeneity with regard to the definition of AMI, the population with diabetes, and geographic differences.

Conclusion: Incidence of AMI in people with diabetes remained significantly higher than in those without diabetes. A reduction in the incidence of AMI over time was observed in some, but not all reviewed studies in people with diabetes. There was no discernible trend of estimates comparing people with and without diabetes. These findings underscore the necessity for additional initiatives to prevent coronary heart disease in people with diabetes. The observed discrepancy in study results is presumably attributable to variations in the population and regional contexts, as well as to disparate methodological approaches. More standardized studies employing comparable methodologies are therefore required.

Systematic review registration: PROSPERO CRD42 02014 5562.

Objective: This scoping review aims to provide an overview of documents describing the preparation of policy briefs from academic health science researchers for policy-making.

Introduction: Not considering research evidence sufficiently may engender inefficient resource allocation and an inadequate response to public issues. Policy briefs are aimed at bridging this gap and assisting policy-makers in making evidence-informed decisions, yet they lack standardization.

Methods: A scoping review following JBI methodology was conducted. We aimed at summarizing recommendations and guidelines for policy briefs from health science academia, focusing on formal criteria and contextual considerations. We included documents describing the preparation of policy briefs from academia to policy-making, as well as those that are usable for various addressees. Documents needed to be published in German, English, French, or Spanish and available in full text. Searches were conducted in PubMed, Embase, Web of Science, LIVIVO (SOMED), and additional sources up to December 01, 2025, resulting in 67 included records out of 1395 scientific publications and 81 grey literature sources.

Results: The structure of policy briefs varied, with layout and language being the only consistent elements. Guidelines exhibited diversity in length, target groups, references, and timing, with discernible tendencies. Contextual considerations also varied across articles, indicating inconsistency in definitions and frequencies.

Conclusion: Variability in policy brief design guidance poses challenges for both researchers and end-users, potentially hindering effective evidence communication. Enhanced efforts of co-creation, shared minimum standards, and evaluation may mitigate these challenges. Still, complete standardization may be unattainable, necessitating flexibility to cater to diverse audience needs, priorities, and perspectives. Transparent acknowledgement of such situations is crucial.

Systematic review registration: https://doi.org/10.17605/OSF.IO/HTJMW.

Background: To support the development of a national guideline on stem cell therapy, the Department of Health Research, India, commissioned this systematic review to evaluate the efficacy and safety of various stem cell types in patients with type 1 and type 2 diabetes mellitus (DM), focusing on patient-important outcomes.

Methods: Following PRISMA guidelines, a literature search was conducted in PubMed, Embase, Web of Science, and Cochrane databases from inception to August 30, 2024. Critical outcomes for type 1 DM included insulin-free periods, hypoglycemic episodes, quality of life, and serious adverse events. For type 2 DM, outcomes included HbA1c, insulin requirements at 6, 12, and 24 months, and serious adverse events. Meta-analyses used random- or fixed-effects models based on heterogeneity (Chi-square test and I²). Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0, and evidence certainty was evaluated with GRADE.

Results: The search identified 11,026 articles, of which 20 randomized controlled trials (RCTs) were included, encompassing 427 and 351 patients in the intervention and control groups, respectively, with follow-ups ranging from 3 to 96 months. Predominantly studied therapies included mesenchymal and bone marrow mononuclear stem cells. In type 1 DM, stem cell therapy showed no significant improvement in quality of life [MD: 3.15% (95% CI: -0.80 to 7.10); 2 trials, n = 63 participants; I² = 0%; GRADE: very low certainty] or reduction in hypoglycemic episodes [RR: 0.90 (95% CI: 0.56 to 1.45); 3 trials, 68 participants; I² - 0%; GRADE: very low. In type 2 DM, stem cell therapy significantly reduced insulin requirements at 6, 12, and 24 months, with MDs in IU/day of -14.42 (95% CI: -24.25 to -4.59); 6 trials, n = 167 participants; I² = 91.64%; GRADE: low certainty; -17.79 (95% CI: -26.39 to -9.18); 6 trials, n = 212 participants; I² = 70.96%; GRADE: low certainty; and -35.73 (95% CI: -40.82 to -30.64); 1 trial, n = 61 participants; I² = NA; GRADE: very low certainty, respectively, with a low certainty of evidence.

Conclusion: Stem cell therapy did not achieve an insulin-free state or improved quality of life in type 1 DM patients. However, it reduced insulin requirements by 14-36 units over 6-24 months in type 2 DM patients, without significant glycemic control. Larger, high-quality RCTs with extended follow-ups are essential to determine the therapeutic potential of stem cell therapy in diabetes mellitus.

Systematic review registration: PROSPERO ID: CRD42023451602.

Background: Rare diseases (i.e., incidence of <1/2000) are individually uncommon, but collectively these 10,000 conditions affect an estimated 473 million people globally, and approximately 70% of rare diseases manifest in childhood. Despite this global impact, 90% of rare diseases lack effective treatment. Treatments for rare diseases are often identified through clinical trials. Identifying parents' knowledge needs and preferences regarding pediatric rare disease clinical trials is an important aspect of empowering parents, improving clinical research practices, and potentially improving recruitment to these vital trials. The aim of the scoping review is to determine the extent, range, and characteristics of the evidence on the knowledge needs and preferences of parents regarding pediatric rare disease clinical trials.

Methods: A scoping review will be conducted to identify sources of literature on the topic. A systematic search strategy co-developed with a research librarian will be conducted in six databases (Medline, EMBASE, CINAHL, Scopus, Web of Science, and PsycINFO). Gray literature will be searched via Google, Perplexity AI, the ProQuest Dissertations & Theses Global database, and relevant rare disease organizational websites. Abstract and full-text screening will be conducted by two reviewers independently. Studies in English will be included regardless of study design, date of publication, or location of study/publication. Study quality will be appraised using the Mixed Methods Appraisal Tool. Data will be extracted including study characteristics, population, phenomena under investigation, and knowledge needs and preferences identified. Analysis will involve a descriptive numerical summary and qualitative content analysis. Findings will be presented in evidence tables, and patterns, themes, and gaps across the data will be reported using a narrative approach.

Discussion: This review will provide an overview of the existing literature regarding parents' knowledge needs and preferences about pediatric rare disease clinical trials. The findings of this review will inform future research and the development of knowledge translation resources for parents of children with rare diseases.

Systematic review registration: This protocol has been registered in Open Science Framework (registration: https://doi.org/10.17605/OSF.IO/QXR8G ).