Systematic Reviews最新文献

Background: Bacterial culture remains a critical tool for pathogen identification and antimicrobial susceptibility testing. However, its diagnostic accuracy is often compromised by prior antibiotic administration, which can reduce the recovery of viable organisms and lead to false-negative results. Given the variability and limitations in the existing studies, a systematic review is needed to better understand the influence of antibiotics on culture yield.

Methods: We conducted an electronic search in PubMed, Embase, Scopus and Web of Science from their inception through March 2025. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included articles. Random effects models were used to estimate the proportions and 95% Confidence Intervals (CIs). The protocol for this review was registered in PROSPERO: CRD42025648397.

Results: Of the 1226 articles obtained from the search, 11 were eligible. The eligible articles comprised 67,330 samples with culture results after antibiotic administration. The pooled proportion for bacterial growth was 37% (95% CI 20-56%) and 18% (95% CI 10-29%) before and after antibiotic administration, respectively. Significant heterogeneity (I² = 99.8%, p-value < 0.001) was observed across the included studies.

Conclusion: Bacterial growth decreased by more than half following antibiotic administration, indicating a strong suppressive effect. This highlights the importance of considering the timing of sample collection in relation to antibiotic initiation. Where necessary, particularly in cases of uncertain clinical progress, sampling after antibiotic administration can be useful for monitoring prognosis and guiding further treatment decisions.

Systematic review registration: PROSPERO: CRD42025648397.

Introduction: Suicide is one of the leading causes of death worldwide, especially in patients with mental health disorders. Suicidality is an important outcome for patients in psychiatric randomised clinical trials. The aim of this scoping review is to assess whether and how psychiatric trials assess suicidal ideation, suicide attempts, and suicides.

Methods: This is a protocol for a scoping review. We will conduct a search of high-impact journals for randomised clinical trials published since January 2022 that include mental health patients, irrespective of the intervention type. We will assess if and how psychiatric trials assess suicidal ideation, suicide attempts, and suicides.

Discussion: This scoping review will be the first to examine how suicidality is assessed in contemporary randomised clinical trials. In combination with the PIO-Psych Initiative, this scoping review will ultimately guide future researchers in selecting patient-important outcomes and inform clinical research practice. However, the focus on high-impact journals may limit the generalisability of the findings.

Scoping review registration: This scoping review is part of a project that has been prospectively registered on the COMET website ( https://comet-initiative.org/Studies/Details/3125 ).

Purpose: The study aimed to evaluate the diagnostic performance of artificial intelligence (AI) in detecting sudden cardiac death on electrocardiogram (ECG).

Methods: We systematically searched PubMed, Web of Science, Embase, and IEEE Xplore for studies published through April 2025 evaluating AI models for ECG-based sudden cardiac death detection, using expert consensus or database records as the reference standard. A bivariate random-effects model generated pooled sensitivity and specificity estimates. Heterogeneity was quantified via I² and τ² statistics. Study quality was appraised using the revised QUADAS-2 tool, with evidence certainty graded via the GRADE assessment.

Results: Out of 958 initially identified studies, 27 studies with 2613 patients and images were ultimately included for the final analysis. For heart rate variability, AI demonstrated a sensitivity of 0.90 (95% CI: 0.86-0.92) and specificity of 0.91 (95% CI: 0.83-0.96), with an AUC of 0.93 (95% CI: 0.91-0.95). For ECG signal segmentation, AI demonstrated a sensitivity of 0.96 (95% CI: 0.92-0.98) and specificity of 0.99 (95% CI: 0.94-1.00), with an AUC of 0.99 (95% CI: 0.98-1.00). For direct input of ECG lead signals, AI demonstrated a sensitivity of 0.87 (95% CI: 0.61-0.97) and specificity of 0.91 (95% CI: 0.75-0.97), with an AUC of 0.95 (95% CI: 0.93-0.97).

Conclusions: This meta-analysis indicates that AI-based ECG analysis shows potential for SCD prediction. However, the summary estimates are derived from highly heterogeneous studies and should not be considered benchmarks for clinical performance. The current evidence remains preliminary and derived from idealized research settings, underscoring the need for prospective, multicenter studies with standardized methodologies to establish generalizability and clinical applicability.

Background: Telehealth has the potential to mitigate maternal and child health access challenges, reduce health system dependency and healthcare expenditures, and facilitate the delivery of healthcare to women and children remotely.

Methods: Exhaustive searches of the literature were performed across multiple databases, including PubMed, Scopus, PDQ-Evidence for Informed Health Policymaking, CINAHL, EconLit, International Health Technology Assessment (HTA), Google Scholar, and the UniSQ RISE Research Repository. These searches targeted peer-reviewed, English-language articles published from inception to February 2024. The quality of the reports was assessed via CHEERS 2022.

Results: In this review, 20 studies comparing telehealth to usual care for maternal and child healthcare in remote, rural, and regional (RRR) Australia were included. Of these, 18 found telehealth to be a cost-saving option, while two reported comparable costs and outcomes. These findings were assessed from a range of perspectives, including those of the health system, society, family, providers, and third-party payers. The review findings indicate that telehealth has potential for addressing health disparities among women and children in remote, rural, and regional Australia. Health disparities are reduced by overcoming access barriers, reducing expenses, fostering healthy behaviors, increasing service utilization, shortening hospital stays, and enhancing care coordination.

Conclusions: This review highlights that telehealth is a predominantly cost-saving alternative to usual care for maternal and child health services in remote, rural, and regional Australia. It has the potential to reduce health inequality among women and children residing in remote, rural, and regional Australia. A broader evaluation incorporating societal costs and benefits, along with a long-term view of the clinical and economic impacts of telehealth, is essential for its wider implementation.

Systematic review registration: PROSPERO CRD42024518089.

Background: Socioeconomic determinants of health (SDoH) have a significant impact on healthcare, health outcomes, and resulting health inequalities. A wealth of research relating to the adult population exists, including those with long-term health conditions. However, research is lacking on the impact of these SDoH on children and young people with long-term health conditions. Children and young people are also often forgotten when it comes to policies, legislation, and funding to reduce health inequalities. This scoping review aims to explore the extent and quality of research, legislation, and policies in the United Kingdom, in relation to SDoH and the resulting health inequalities in children and young people with long-term health conditions.

Methods and design: A flexible, iterative approach to this scoping review will enhance our ability to explore the impact of SDoH on children and young people with long-term health conditions. This will involve six steps: (1) defining the research question; (2) identifying relevant articles; (3) study selection; (4) charting the data; (5) collating, summarising, and reporting the results; and (6) consultation exercise with key stakeholders. A search of EMBASE, EMCARE, Medline, CINAHL, Cochrane Library, Web of Science Core Collection, Scopus, Sociological Abstracts, and APA PsycINFO will be conducted from 2010 to present to evaluate the published literature following the Equality Act (2010), which set out the legal framework, and the Marmot Review (2010), a strategic review of health inequalities. Manual searching of national and international conferences, government white papers, published reports, and research summaries searched via the Health Research Authority website, and grey literature will be included.

Discussion: This review will inform concurrent work being undertaken at Great Ormond Street Hospital, which aims to develop and implement targeted, evidence-based interventions to reduce the impact of these SDoH and the resulting health inequalities. As such, this review is focused on UK-specific evidence relevant to our healthcare systems and patient population. The inclusion of UK policy and legislative literature will also ensure a real-world perspective and identify current gaps in policy that need to be addressed.

Systematic review registration: This review protocol has been registered within the Open Science Framework database ( osf.io/5ut9x ).

Background: Artificial intelligence (AI) can greatly enhance efficiency in systematic literature reviews and meta-analyses, but its accuracy in screening titles/abstracts and full-text articles is uncertain.

Objectives: This study evaluated the performance metrics (sensitivity, specificity) of a GPT-4 AI program, Review Copilot, against human decisions (gold standard) in screening titles/abstracts and full-text articles from four published systematic reviews/meta-analyses.

Research design: Participant data from four already-published systematic literature reviews were used for this validation study. This was a study comparing Review Copilot to human decision-making (gold standard) in screening titles/abstracts and full-text articles for systematic reviews/meta-analyses. The four studies that were used in this study included observational studies and randomized control trials. Review Copilot operates on the OpenAI, GPT-4 server. We examined the performance metrics of Review Copilot to include and exclude titles/abstracts and full-text articles as compared to human decisions in four systematic reviews/meta-analyses. Sensitivity, specificity, and balanced accuracy of title/abstract and full-text screening were compared between Review Copilot and human decisions.

Results: Review Copilot's sensitivity and specificity for title/abstract screening were 99.2% and 83.6%, respectively, and 97.6% and 47.4% for full-text screening. The average agreement between two runs was 95.4%, with a kappa statistic of 0.83. Review Copilot screened in one-quarter of the time compared to humans.

Conclusions: AI use in systematic reviews and meta-analyses is inevitable. Health researchers must understand these technologies' strengths and limitations to ethically leverage them for research efficiency and evidence-based decision-making in health.

Background: University students are an at-risk population for developing mental health problems which can negatively impact their academic performance, social relationships, physical health, and future life. Among this population, the cohort of international students is more vulnerable. Chinese international students (CIS) form the largest international student group in the world, but research on their mental health is limited. Although researchers have become increasingly interested in their mental health in recent years, a comprehensive review of existing evidence is not yet available. The proposed review aims to integrate quantitative and qualitative findings concerning factors associated with CIS mental health.

Methods: The systematic review will follow the PRISMA guidelines. Nine online databases-six English language and three Chinese language-will be searched. Peer-reviewed journal articles will be examined and screened according to the inclusion and exclusion criteria. Both quantitative and qualitative data will be extracted and narratively synthesised to generate an improved understanding of factors associated with the mental health of CIS.

Discussion: Findings from this systematic review will provide researchers, education professionals, mental health workers, and universities with knowledge concerning the factors associated with CIS mental health that is necessary for practical actions and will inform further research.

Systematic review registration: PROSPERO CRD42023402503.

Background: Thalassemia is a genetic hemoglobin disorder commonly associated with iron overload and cardiac complications from repeated transfusions. Deferiprone (DFP), an oral iron chelator, has shown potential in reducing body iron and improving cardiac function. This systematic review and meta-analysis evaluates the efficacy and safety of DFP in thalassemia patients.

Methods: A systematic search of PubMed, MEDLINE, and Scopus was conducted from inception to June 8, 2025. Eligible randomized controlled trials (RCTs) enrolled thalassemia patients receiving iron chelation therapy and compared DFP (alone or in combination) with deferoxamine, deferasirox, placebo, or no chelation. Non-randomized studies, those without comparators, or lacking sufficient data were excluded. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence by GRADE. Pooled standardized mean differences (SMDs) the inclusion criteria; 18 were included in the meta-analysis. DFP significantly improved left ventricular ejection -effects model.

Results: Twenty-three RCTs (n = 1,005) met the inclusion criteria; 18 were included in the meta-analysis. DFP significantly improved left ventricular ejection fraction (SMD: 0.55) and shortening fraction (SMD: 0.37). Non-significant improvements were observed in urinary iron excretion and right ventricular ejection fraction. No significant effects were found for serum ferritin, liver iron concentration, or cardiac T2* MRI. DFP increased the risk of adverse events (RR: 1.37), but not mortality (RR: 0.30). Evidence certainty was moderate for cardiac function and adverse events, and low for other outcomes.

Conclusion: DFP improves cardiac function and iron excretion with an acceptable safety profile in thalassemia. Further high-quality RCTs are warranted to confirm its role and optimize regimens.

Systematic review registration: PROSPERO CRD420251028324.

Introduction: Maternal health remains a critically neglected issue in low-resource countries and represents a significant public health concern. Maternal mortality in these regions is ten times higher than in high-income countries. Sub-Saharan Africa bears the highest maternal mortality ratio globally. The persistently high maternal mortality rate is attributed to the myriad professional, social, and economic challenges healthcare providers face, which impede their ability to deliver optimal maternal healthcare. Given the central role of healthcare professionals in maternal health, understanding the barriers and facilitators they encounter is essential to improving maternal health outcomes. This systematic review aims to synthesise the existing literature on the challenges and enablers of providing maternal healthcare in Africa.

Method: The review will involve a comprehensive search using databases such as MEDLINE, CINAHL, Google Scholar, and PubMed, accessed through the City St. George's University library. The search strategy will be refined with input from the school librarian to ensure thoroughness. Search terms will include Medical Subject Headings (MeSH) terms like "Barriers OR challenges," "Facilitators OR Enablers," "maternal health," and "Africa," alongside relevant keywords. Boolean operators "AND" and "OR" will expand the search scope, with inclusion criteria limited to English-language articles published between 2010 and 2025 with available abstracts, studies conducted in African countries, and qualitative articles addressing barriers and/or facilitators of maternal healthcare. The SPIDER framework will guide the research question, adhering to PRISMA guidelines for systematic reviews, while STARLITE principles will report on the literature search process. The selected studies will be appraised using the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies.

Result: Data will be analysed thematically following the approach outlined by Thomas and Harden (2008), presenting findings as an interpretive summary.

Conclusion: This review will enhance the existing evidence on the challenges and opportunities faced by maternal healthcare providers in delivering better services across Africa.

Ethics and dissemination: No formal ethical approval is necessary since this study does not involve collecting primary data. The findings will be shared via a peer-reviewed journal article and presented at conferences.

Systematic review registration: (PROSPERO) CRD42025634335.