To systematically assess the efficacy of digital health interventions (DHIs) for improving treatment adherence among dialysis patients through a meta-analysis of randomized controlled trials (RCTs).

Five databases were systematically searched from inception to April 2024. Meta-analyses were performed to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) for adherence outcomes. Evidence quality was evaluated using the GRADE approach.

Seventeen RCTs involving 1,438 dialysis patients were analyzed. DHIs significantly improved overall adherence (SMD 1.88 [95% CI: 0.46-3.29]; 4 trials, low-certainty evidence). Specifically, DHIs demonstrated large improvements in medication adherence (SMD 1.45 [95% CI 0.38-2.52]; 4 trials, 300 patients; low-certainty evidence) and dialysis treatment adherence (SMD 1.88 [95% CI 0.46-3.29]; 4 trials, 245 patients; low-certainty evidence). Moderate improvements were observed in dietary adherence (SMD 0.58 [95% CI 0.25-0.91]; 4 trials, 344 patients; moderate-certainty evidence) and fluid management adherence (SMD -0.36 [95% CI -0.64 to -0.07]; 7 trials, 619 patients; moderate-certainty evidence).

Digital health interventions effectively enhance multiple dimensions of treatment adherence in dialysis patients, underscoring their value for incorporation into routine clinical practice.

Legal gender recognition (LGR) refers to laws, policies, and administrative procedures that enable transgender and gender diverse (TGD) people to update their legal identity documents (ID) to reflect their self-determined gender. We conducted a systematic review and meta-analysis on the health effects of LGR and a nested scoping review of TGD people's LGR-related values and preferences (PROSPERO CRD42023441769). We searched seven databases through April 19, 2024, and organization websites (for grey literature) through August 2023. The effectiveness review included quantitative studies evaluating the effect of LGR (policies or possession of gender-concordant ID) on seven domains of health and well-being. We conducted random-effects meta-analyses when possible and otherwise used narrative synthesis. Study risk of bias and confidence in the cumulative evidence were assessed using the ROBINS-E and GRADE, respectively. We screened 2748 studies and included 24 in the effectiveness review. In meta-analyses, LGR was associated with less suicidal ideation (OR = 0.75; 95 % CI: 0.56-1.00, I2 = 46 %) and psychological distress (e.g., OR for LGR on all versus no ID = 0.53; 95 % CI: 0.40, 0.70, I2 = 17 %). LGR may reduce anticipated discrimination, increase healthcare utilization, reduce gonadectomies, and improve socio-economic status, but the evidence was very uncertain. We included 31 studies on TGD persons' values and preferences. They perceived well-being benefits of LGR, had diverse personal preferences related to safety, and reported financial and policy barriers to LGR. In conclusion, LGR may improve TGD mental health and is perceived to reduce exposure to stigma and discrimination. Higher-quality effectiveness research is needed on other health and well-being outcomes, as well as research to evaluate specific LGR policy provisions.

Menopause, a crucial transitioning stage for women, can significantly impact mood and wellbeing. We aimed to systematically examine the effectiveness of Mindfulness-based interventions (MBIs) on health outcomes, including menopausal symptoms, quality of life (QOL), sleep quality, anxiety, depressive symptoms, stress, mindfulness levels, and female sexual function index.

Eight databases were searched from inception to November 4, 2024 for randomized controlled trials. Two researchers independently selected, extracted, and appraised trials using the Cochrane Collaboration's 'risk of bias' tool. Meta-analysis, subgroup analysis, leave-one-out sensitivity analysis, and meta-regression were performed using Stata 18.0. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

A total of 19 studies (1670 participants) published between 2011 and 2024 were identified. Of these, 18 studies were included in the meta-analysis. Compared with control group, The pooled analysis demonstrated that MBIs had statistically significant effects on menopausal symptoms (SMD, -2.10; 95 % CI, -3.49 to -0.70), QOL (SMD, -0.88; 95 % CI, -1.67 to -0.09), sleep quality (SMD, -0.92; 95 % CI, -1.65 to -0.20), anxiety (SMD, -1.03; 95 % CI, -1.42 to -0.66), depressive symptoms (SMD, -0.91; 95 % CI, -1.30 to -0.53), stress (SMD, -0.85; 95 % CI, -1.55 to -0.15), and mindfulness levels (SMD, 1.19; 95 % CI, 0.35 to 2.02). The overall quality of evidence for all pooled estimates were graded as low and moderate due to methodological limitations and small sample size. The low attrition rate (6 %) and relatively high adherence rate (79 %) highlight the acceptability of MBIs.

This systematic review and meta-analysis support using of MBIs to improve health outcomes in menopausal women. Rigorous randomized controlled trials with extended follow-up are needed to elucidate the mechanisms linking MBIs to menopausal health and strengthen evidence for clinical application.

Acute kidney injury (AKI) is a frequent complication of cardiac surgery, contributing to increased morbidity, longer hospital stays, and higher mortality. Evidence suggests amino acid (AA) supplementation may enhance renal blood flow and glomerular filtration rate (GFR), potentially reducing AKI risk; however, findings remain inconclusive. This study evaluated the efficacy of perioperative AA supplementation in preventing AKI and related complications post-cardiac surgery.

PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing AA supplementation versus standard care in preventing cardiac surgery-associated AKI. Main outcomes included AKI incidence (defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria), 30-day mortality, and renal replacement therapy (RRT) requirement. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Statistical significance was set at p < 0.05. The certainty of the evidence (CoE) was assessed using the GRADE approach.

Six RCTs involving 4501 cardiac surgery patients were included. AA mixture interventions significantly reduced the risk of AKI stage 1 (RR: 0.56; 95% CI: 0.77-0.96; p = .009; CoE: Moderate) and Stage 3 (RR: 0.53; 95% CI: 0.34-0.83; p = .005; CoE: Moderate), but not stage 2 (RR: 1.24; 95% CI: 0.60-2.55; p = .568; CoE: Low). Preliminary findings from glutamic acid and glutamine (single AA interventions) showed potential benefits in reducing AKI incidence (CoE: Very low) and improving surrogate biomarkers, respectively. No significant effects were observed on mortality or RRT incidence for any intervention.

AA mixtures likely reduce AKI incidence following cardiac surgery but show limited effects on mortality and RRT. Further trials are needed to confirm the benefits of glutamic acid and glutamine supplementation.

Use of amino acid supplementation for the prevention of acute kidney injury after cardiac surgery may be effective, but more trial data and confidence in a beneficial effect is needed for this to be implemented in everyday clinical practice.

Mindfulness-based therapies (MBT) are proposed as a "third wave" of cognitive-behavioral therapy (CBT). This network meta-analysis investigated this hypothesis by comparing the effectiveness of MBT and CBT for treating depression, measured by the Beck Depression Inventory-II (BDI-II).

An indirect comparison was made. Relevant databases were searched for studies comparing either CBT or MBT with treatment as usual (TAU). Mean differences (MD) between intervention and TAU were calculated using changes from baseline from both intervention (Me) and TAU-group (Mc). MDs of CBT and MBT were compared in a network meta-analysis. Results were reported for both the common-effects-model (CEM) and the random-effects-model (REM). Risk of Bias (RoB) was measured using the RoB-2-tool. Quality of evidence was investigated based on GRADE.

Eight MBT and ten CBT studies, meeting eligibility since 2006, were included. MBT studies included behavioral activation with mindfulness, mindfulness-based cognitive therapy, person-based cognitive therapy, and a newly developed meditation-based lifestyle modification program. Both CBT and MBT differed significantly from TAU. In the unweighted CEM network meta-analysis, MBT showed significantly better treatment effect, but this was below the clinically relevant threshold (MD:-1.81). For REM and weighted analysis, there were no significant differences between CBT and MBT.

Heterogeneity, high RoB, and low evidence quality were notable, with indirectness limiting this analysis.

CBT and MBT both showed significant and clinically important treatment effects for depression. However, an outstanding benefit of MBT in comparison to CBT could not be found in this analysis. Further research could include a direct comparison.

Postpartum depression (PPD) significantly affects well-being and the ability to function normally, making preventive strategies crucial. The role of intravenous ketamine in preventing PPD, especially after cesarean sections under neuraxial anesthesia, remains unclear and controversial.

This systematic review and meta-analysis aimed to assess the efficacy and safety of perioperative intravenous ketamine administration in preventing postpartum depression among women undergoing cesarean section under neuraxial anesthesia.

A comprehensive electronic search was conducted for literature published from 2000 to January 1, 2023, in multiple databases, including PubMed/MEDLINE and the Cochrane Database of Systematic Reviews, using relevant keywords. Language restrictions were not applied.

The included studies were randomized controlled trials (RCTs) that met the following criteria: adult patients (<18 years) undergoing elective cesarean section under neuraxial anesthesia, peripartum intravenous administration of ketamine, placebo as a comparison group, and postpartum depression as the primary outcome.

Data were extracted on various parameters, including study characteristics, ketamine protocol, control group details, results, and quality assessment scores. Meta-analysis was performed using the RevMan 5.4 statistical package, and outcomes were assessed using odds ratios (ORs) for dichotomous data and mean differences (MD) for continuous data, using a random effects model.

Ten studies involving 2219 patients (1094 in the ketamine group and 1125 in the control group) were included. The meta-analysis did not show significant differences in the incidence of PPD or EPDS scores between the ketamine and control groups postoperatively. However, ketamine administration resulted in a reduction in postoperative pain scores and total opioid consumption but increased the incidence of headaches.

Perioperative intravenous administration of ketamine does not have a prophylactic effect on postpartum depression in patients undergoing cesarean section under neuraxial anesthesia but does reduce postoperative pain and total opioid consumption. The increased incidence of side effects, such as headaches, dizziness, and drowsiness, warrants further investigation. Additional large RCTs are necessary to further explore ketamine's potential prophylactic effect on PPD.

HIV and tuberculosis (TB) are two of the most devastating disease conditions of public health concern globally. A co-infection of the two diseases poses serious health challenges to patients including mental health problems, ranging from mild to severe, with differing outcomes. This systematic review aims to assess the correlates of HIV-TB co-infection and mental health of adults living in sub-Saharan Africa.

We will conduct comprehensive database and non-database searches for studies (published and unpublished). We will search Google Scholar, PubMed, CINAHL, LILACS, JSTOR, Cochrane Library, SCOPUS, PsycINFO, HINARI and African Journals Online from inception to 31 May 2025, without restriction on language. We will also search the grey literature, including conference proceedings, preprint repositories, databases of dissertations, WHO and governmental databases. In the event where there is a need to contact experts and corresponding authors for further information, the review team will do so to enrich the content of the review. At least three reviewers will independently undertake study selection, data extraction and risk of bias assessment using validated tools. We will resolve discrepancies or disagreements through discussion. We will analyse dichotomous data as risk ratio, OR or proportion and continuous data as mean difference with their SD; all estimates will be presented with their 95% CI. Where applicable, we will determine SD from point estimates and the appropriate denominators assuming a binomial distribution. The magnitude of heterogeneity between the included studies will be assessed quantitatively using the index of heterogeneity (I2 statistic). The I2 values of 25%, 50% and 75% will be considered to represent low, moderate and significant heterogeneity. The significance of heterogeneity will be determined by the p value of the I2 statistic, and a p value of <0.05 will be considered as statistically significant. For studies with moderate to significant heterogeneity, the random-effects model will be used to obtain a pooled estimate of the outcome, and if heterogeneity is low, a fixed-effect model will be used.

This systematic review will collate secondary research based on publicly available published and unpublished studies, and no ethical approval is required. However, an eligible study with serious ethical issues will be excluded and the reasons for exclusion documented. The review findings will be shared with key stakeholders, health authorities, agencies involved in the mental health of persons living with HIV-TB (PLHTB) co-infection, social services providers and policy implementers. The findings will be presented at scientific conferences and symposia. The final review report will be in the form of a scientific paper in a high-impact factor peer-reviewed journal.

CRD42024572331.

While the development in multimodal therapies has helped improve treatment outcomes for patients with locally advanced gastric adenocarcinoma (LAGC), there still exist disparities in opinion with an optimal treatment plan. This consensus hopes to provide clinicians with structured guidelines to aid in the decision-making for treatment options for LAGC.

The consensus statement was initiated by establishing a taskforce in collaboration with the Asia Pacific Gastroesophageal Cancer Congress (APGCC) and a multidisciplinary expert panel was selected. Clinical questions on LAGC where perceived variance in practice or opinion may exist were formulated. Studies involving patients with Stage 2 or 3 gastric or Siewert 3 junctional cancers with treatment arms of perioperative chemotherapy, neoadjuvant chemotherapy, adjuvant chemotherapy, immunotherapy and surgery were included. A total of two rounds of voting were performed. Consensus was determined to be reached when a single answer or a combination of either "strongly agree/agree" or "strongly disagree/disagree" responses exceeded 75%.

A total of thirteen clinical questions were developed. They were identified through five main categories: Distal LAGC, Proximal LAGC, Deficient mismatch repair tumors, Chemotherapy and Immunotherapy, and Elderly/Unfit patients. After two rounds of voting by our multidisciplinary expert panel, eleven out of a total thirteen clinical questions had reached consensus. No consensus was reached for two clinical questions.

The APGCC consensus statement aims to guide clinicians in the treatment options for LAGC and Siewert 3 junctional cancer and has clarified some of the roles of perioperative chemotherapy and immunotherapy.

The Diaphragmatic Rapid Shallow Breathing Index (D-RSBI) has been proposed as a promising tool for predicting successful weaning from mechanical ventilation. By focussing on diaphragmatic activity, the D-RSBI aims to overcome the limitations of the classic rapid shallow breathing index, providing a more specific assessment of the patient's ability to sustain independent breathing following extubation.

Two investigators conducted independent systematic searches in the PubMed, Embase, Cochrane Database, Scopus, Medline, Science Direct, and Epistemonikos databases, covering publications from inception to 30 November 2024. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A meta-analysis was performed using the random-effect model, calculating sensitivity, specificity, diagnostic odds ratio, and the area under the summary receiver operating characteristic curve for the D-RSBI. The systematic review protocol was registered in the Centre for Reviews and Dissemination database 42024582489 of the Prospective International Registry of Systematic Reviews. Subgroup analyses, bivariate meta-regressions, and sensitivity analyses were conducted. Publication bias was evaluated using a funnel plot, along with Begg's and Egger's tests. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology.

Fourteen studies were included in the meta-analysis, comprising a total of 1104 patients. The D-RSBI score was significantly lower in the successful weaning group than in the failure group, with a mean difference of -1.09 (95% confidence interval: -1.36 to -0.82; p < 0.05). The pooled sensitivity was 0.88, specificity was 0.82, and the area under the curve was 0.93. The diagnostic odds ratio was 45.2 (95% confidence interval: 23.5 to 87.2; p < 0.05). The studies included were of moderate to high quality, and the certainty of the evidence was rated as moderate.

The D-RSBI appears to be a promising predictor for forecasting the success of weaning from mechanical ventilation, offering adequate sensitivity and specificity. However, further clinical trials are needed to confirm and validate these findings and thus to establish the score's potential for enhancing the clinical management of weaning in critically ill patients.

To evaluate the efficacy and safety of mineralocorticoid receptor antagonists (MRAs), specifically eplerenone and spironolactone, in comparison to observation, photodynamic therapy (PDT), and subthreshold micropulse laser (SML) for chronic central serous chorioretinopathy (cCSCR).

In the context of cCSCR, MRAs are thought to reduce choroidal vascular hyperpermeability and thickness by inhibiting the mineralocorticoid receptor pathways that contribute to fluid accumulation.

A systematic literature search was performed using Ovid MEDLINE, Embase, and the Cochrane Library from January 2000 to March 2024 for comparative studies evaluating the efficacy of MRAs against other treatment arms for cCSCR. The primary outcome was the best-corrected visual acuity (BCVA) at the last study visit, as well as at specific follow-up timepoints (i.e., 1 month, 3 months, 6 months, 12 months). Secondary outcomes included retinal thickness (RT), subretinal fluid (SRF) height, and SRF resolution at the same timepoints. Meta-analyses were performed using a random-effects model, with subgroup analyses performed for eplerenone and spironolactone separately. A p-value of less than 0.05 was considered statistically significant.

Thirteen articles (four RCTs reporting on 253 eyes and nine observational studies reporting on 393 eyes, mean follow-up duration=7.02 ± 3.78 months) were included. The mean BCVA at the last study visit was similar between the MRA and observation groups (WMD=-0.01 logMAR, 95%CI=[-0.05, 0.02], p=0.40, n=5 studies). However, MRAs resulted in a significantly lower mean SRF height at 1 month (WMD=-69.56 µm, 95% CI [-127.26, -11.86], p=0.02, n=2 studies), while the observation group had a significantly lower SRF height at 12 months (WMD=48.23 µm, 95% CI [45.99, 50.46], p<0.00001, n=2 studies). Likewise, Similarly, MRAs demonstrated a higher rate of SRF resolution at 1 month (RR=4.24, 95%CI=[1.54, 11.72], p=0.005), whereas the observation group showed a higher resolution rate at 12 months (RR=0.45, 95%CI=[0.22, 0.95], p=0.04). On subgroup analysis, spironolactone showed a significantly reduced mean RT at the last study visit compared to observation (WMD=-46.44 µm, 95% CI [-74.76, -18.13], p=0.001, n=2 studies). When compared to PDT, MRAs were associated with a significantly higher mean SRF height at the last study visit (WMD=51.99 µm, 95% CI [2.70, 101.27], p=0.04, n=2 studies). In contrast, efficacy outcomes were largely similar between patients treated with MRAs and SML at the last study visit, with no significant differences in SRF resolution (p=0.22, n=2 studies).

MRAs offer short-term benefits in reducing SRF but may have limited long-term durability based on current evidence, highlighting the need for further studies.

Depression severely impacts quality of life globally. While traditional treatments show efficacy, many patients respond poorly. Nutritional interventions demonstrate potential as safe, economical adjunctive therapies. However, current evidence is scattered and heterogeneous, lacking systematic evaluation. This study aims to systematically evaluate evidence for various nutritional interventions in depression and create an evidence gap map (EGM).

We will conduct a systematic review using the EGM approach. Major medical databases will be searched for relevant studies published up to present. Two independent researchers will screen literature, extract data, and assess evidence quality. Multiple tools will be used for quality assessment: Cochrane Risk of Bias Tool 2.0 for RCTs, ROBINS-I for non-RCTs, Newcastle-Ottawa Scale for observational studies. The GRADE system will be employed for overall evidence grading. EPPI-Reviewer Web will generate the EGM. We will analyze evidence distribution, time trends, and explore impacts of population characteristics and depression subtypes.

This study will provide critical methodological references for nutritional psychiatry. Expected results include identifying nutrient categories with robust antidepressant evidence, evaluating evidence distribution for different interventions, and exploring differential effects across populations and depression subtypes. Findings will inform individualized nutritional strategies, improve clinical guidelines, and potentially influence public health policies.

CRD42024590644. Date of registration: 30/09/2024.

The 24-hour movement guidelines consider movement behaviours (sleep, exercise, sedentary time) together within the frame of our 24-hour limit to provide recommendations on how a physically healthy day should look. There is increasing evidence that daily movement behaviours are associated with mental health. However the research into the relationship between 24-hour-movement and mental health, particularly in adults, is still to be systematically reviewed. The aim of this systematic review was to synthesise the current state of knowledge regarding movement behaviours and mental health in non-clinical child, adolescent and adult samples. systematic literature search of PubMed, Scopus and Embase was conducted in 2022, and updated in 2024. The review was preregistered (PROSPERO: CRD42022312717). Due to heterogeneity of methods and analyses, narrative synthesis of the results was employed. Of 103 eligible studies, one was a randomised controlled trial and the remainder were observational. In children 19/27 studies (70%) found at least one significant positive relationship between movement behaviour and mental health, in adolescents 38/41 (93%) and in adults 41/46 (89%). Certainty of evidence was low. More controlled studies are needed to make causal conclusions, but it is evident that the composition of movement behaviours is associated with mental health, and these associations may be differentially manifest in different age groups. This has implications for public health and mental health campaigns.

The National Society of Genetic Counselors (NSGC) planned to develop an evidence-based guideline on the outcomes of genetic counseling for individuals at risk for hereditary cancer. The practice guideline workgroup used Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology including ranking the importance of outcomes of genetic counseling for individuals at risk for hereditary cancer. However, due to evidence gaps in the literature, particularly the limited availability of high quality and well-designed studies for many important outcomes of genetic counseling, the NSGC identified a need for additional research prior to guideline development. Herein, we describe a "call to action" for future research, particularly for health services-related outcomes of genetic counseling in diverse populations. Identified research priorities include conducting high-quality studies that separate the outcomes of genetic counseling from genetic testing, assessing outcomes associated with pre- and/or post-test genetic counseling, measuring patient-reported and health system-reported outcomes, comparing genetic counseling by certified genetic counselors versus non-genetics-trained providers, differentiating need in various hereditary cancer indications, and identifying barriers to genetic counseling in historically excluded patient communities.

The aim of this review was to summarize the effectiveness of respiratory muscle training (RMT) in athletes in muscle strength, lung function and performance of athletes. Searches without date limits or language restrictions, in the databases: Medline via PubMed, Lilacs via Virtual Health Library, CENTRAL through the Cochrane Library, PEDro, EMBASE, ClinicalTrials.gov, reference lists of retrieved articles and gray literature. The selection of studies and data extraction was performed in duplicate by two independent reviewers. Twenty-five articles (involving 522 athletes) provided sufficient information to be included in the meta-analyzes. Most studies included swimmers and soccer players. The RMT was most commonly performed between 30 and 90% of MIP and/or MEP. Furthermore, in a meta-analysis involving 18 studies (different sports), RMT was favorable to increase MIP values (DM = 27.90cmH2O 95% CI: 16.18cmH2O to 39.62cmH2O, p = 0.00001) and in the meta-analysis involving soccer players, MEP values increased significantly (MD = 31.77cmH2O 95% CI: 22.49cmH2O to 41.05cmH2O, p = 0.00001). We conclude that the TMR favors the improvement of pulmonary function: MIP, FEV1, FVC, Tiffenau Index in athletes, mainly soccer players, who also improved their physical performance. However, these results are based on very low to low quality evidence.

To systematically review the evidence on the effectiveness of Isostretching on pain, physical function and quality of life in individuals with Low Back Pain (LBP).

We searched the following databases until November 11, 2024: PubMed, Embase, Cochrane CENTRAL, CINAHL, PEDro, Virtual Health Library Regional Portal, Scopus, Web of Science, SportDiscus and Rehabilitation and Sports Medicine. PRISMA-S was used to strengthen the reporting quality of our search strategy.

This review followed the PRISMA checklist. Randomized clinical trials that investigated the effects of Isostretching against any control intervention in individuals with non-specific LBP were eligible. Literature screening and data extraction were performed independently by the authors. The PEDro scale, the GRADE approach and the TIDier checklist were used to assess the risk of bias, quality of the evidence and reporting quality of the intervention, respectively. Results were analysed and synthesised narratively.

Five articles were included (pooled n = 155). Only adults (76% female) between 19 and 60 years were included. The PEDro score ranged from 2-8 points (mean of 5.6). Very-low quality evidence suggests that isostretching may reduce pain and improve functional capacity in the short term when compared with no intervention. Also, very-low quality evidence suggests that isostretching is not superior to any active intervention to reduce pain and improve functional capacity and quality of life. The mean number of reported TIDier items was 6.4.

This review supports Isostretching to reduce pain and improve physical function and quality of life in patients with non-specific LBP.

To determine the quality and extent of sociodemographic reporting in the contemporary Canadian ophthalmology literature.

Cross-sectional study.

All full-length primary studies involving human participants published in the Canadian Journal of Ophthalmology from January 2020 to December 2022 were included.

A total of 669 studies were screened, and 213 studies were eligible for inclusion. Sociodemographic information reported in eligible studies included age (97.18%), sex (88.26%), comorbidities (25.35%), level of education (5.16%), socioeconomic status (2.82%), and occupation (1.14%). Of the relevant studies, 54 (25.35%) included racial or ethnic data. Canadian studies were 1.84 times less likely than studies conducted outside Canada to report race or ethnicity (p = 0.018), but 13 times more likely to report level of education (p < 0.001). Few articles provided information on how racial or ethnic data were collected (12.96%), why the racial or ethnic classification reported in the study was used (5.56%), why race or ethnicity was assessed in the study (24.07%), whether the classification options used were defined by the investigator or the participant (5.56%) or defined the variable race (1.85%). Some studies reported Indigenous participants (18.52%), and no studies with Indigenous participants reported engagement with Indigenous interest holders in the research process.

Most studies reported age and sex or gender, while the reporting of other equity-relevant sociodemographic data was low. In particular, the reporting of racial or ethnic data was limited. Improved sociodemographic reporting may help stakeholders better identify and address national disparities in ocular health.

The efficacy of conservative interventions targeting temporomandibular disorders (TMDs) in patients diagnosed with headaches has not been systematically reviewed.

To appraise the efficacy of conservative interventions targeting TMDs for adults with primary or secondary headaches.

Bibliographic searches were conducted up to September 2024 for randomised controlled trials in five databases: CINAHL, Cochrane CENTRAL, Embase, PEDro and PubMed. Outcomes collected were frequency, intensity and duration of headache episodes, and disability. Version 2 of the Cochrane Risk-of-Bias Tool and the GRADE approach were used for assessing the methodological quality and grading evidence. Results from trials with similar interventions and with similar outcome measures were pooled into separate meta-analyses.

Five trials were included. Low-certainty evidence suggests that the occlusal stabilisation appliance did not reduce headache frequency (SMD episode/week: -1.57; 95% CI: -2.86 to -0.28; 3 RCTs; n = 145) and intensity (SMD VAS: -0.24 points out of 10; 95% CI: -0.67 to 0.20; 2 RCTs; n = 85) compared to non-specific appliance therapy or no treatment at 1-3 months post-intervention. At 4-9 months post-intervention, low-certainty evidence indicates that the occlusal stabilisation appliance therapy reduced headache frequency (SMD episode/week: 1.21; 95% CI: 0.06 to 2.36; 3 RCTs; n = 145), but not headache intensity (SMD VAS: -0.51 point out of 10; 95% CI: -1.01 to -0.02; 2 RCTs; n = 85). Very low-certainty evidence suggests that overall physiotherapy interventions reduced headache intensity compared to non-specific exercises at 1-3 months post-intervention (SMD NPRS: 4.44 points out of 10; 95% CI: -0.46 to 9.34; 2 RCTs; n = 67) and at 4-9 months post-intervention (SMD NPRS: 3.92 points out of 10; 95% CI: 0.75 to 7.09; 2 RCTs; n = 67).

Our results suggest that clinicians may consider combining orofacial stabilisation appliance therapy and physiotherapy interventions without certainty of their effects for the criteria assessed. The heterogeneity of the interventions assessed and the populations studied means that caution must be exercised when interpreting the results obtained.

#CRD42023389507.

This systematic review aimed to evaluate the effectiveness of computer-controlled local anesthetic delivery (CCLAD) systems in reducing injection pain in pediatric patients aged 3-14 years, including subgroup analysis across different injection techniques.

Randomized controlled trials comparing pain perception associated with CCLAD versus conventional injection methods in children published from January 2015 to November 2024 were included.

Comprehensive searches were performed in Embase, Medline (via PubMed), Cochrane Library, Scopus, Web of Science, and Google Scholar, limited to articles published in English.

From 1253 identified studies, 20 met the inclusion criteria. Meta-analysis revealed that CCLAD significantly reduced pain perception based on the Wong-Baker Pain Rating Scale (WBS) (SMD = -0.98, p = 0.011) and heart rate (HR) measurements (SMD = -0.25, p = 0.013), with high and moderate heterogeneity, respectively. Subgroup analysis indicated significant pain reduction with CCLAD compared to conventional Inferior Alveolar Nerve Block (IANB) on WBS, though findings varied across other scales and injection methods, demonstrating some non-significant differences. No significant differences were observed in other pain assessment parameters. The overall risk of bias was low in five studies, with evidence certainty ranging from very low to moderate.

CCLAD demonstrates potential as a non-pharmacological tool for reducing injection pain in children, particularly as assessed by WBS and HR. Furthermore, CCLAD significantly reduced pain compared to conventional IANB injections in subgroup analyses. Additional research is necessary to optimize treatment protocols and further evaluate the impact of CCLAD on objective pain measures.

This study highlights the benefits of CCLAD in pediatric dentistry, particularly its effectiveness in minimizing pain and stress during local anesthetic injections, especially for IANB procedures. Using CCLAD can enhance patient comfort, improve cooperation, and foster a positive dental experience, thereby supporting better treatment outcomes in pediatric patients requiring precise and low-pain care.

Predicting the public health impact of policies limiting antimicrobial use (AMU) in livestock requires quantifying the link between AMU and antimicrobial resistance (AMR) in foodborne pathogens. Using cattle and Salmonella as an example, we conducted a systematic review and meta-analysis (SRMA) (PROSPERO #CRD42023399764) to elucidate AMU's impact on AMR in bacteria from animals raised both conventionally (CONV) and without AMU (RWA).

Using a predefined population (cattle), intervention (AMU), comparison (CONV vs. RWA), and outcome (AMR in Salmonella or commensal Escherichia coli) framework, 36 studies met the inclusion criteria. We estimated pooled odds ratios (POR) describing the association between AMU and Salmonella prevalence, tetracycline, ciprofloxacin, and third-generation cephalosporin (3GC) resistances and evaluated evidence certainty using a GRADE approach. Predictive intervals (PIs) incorporating heterogeneity (τ2) were calculated along with POR to illustrate the effect of between-study differences on association estimates.

Poor evidence certainty was driven by a high risk of bias, imprecise odds ratio estimates, and inconsistency among the included studies. Substantial heterogeneity was observed, and PIs reflected non-significant associations for all AMR outcomes.

Given the poor certainty of evidence and between-studies differences, pooled estimates should not be trusted, necessitating a suitable alternative to estimate the effects of AMU reduction on human health.

While numerous reviews examine digital interventions, including computer game-based, evidence regarding their effectiveness for ADHD symptoms remains mixed. Focusing on computer game-based interventions, this study aims to identify specific intervention features and trial-related factors that influence outcomes in pediatric ADHD symptoms through a systematic review and meta-analysis of randomized controlled trials.

Comprehensive literature searches were conducted in Web of Science, PubMed and PsycINFO. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Seventeen studies were included. Beyond common game characteristics, some interventions incorporated additional elements-such as neurofeedback, physical exercise via virtual reality (VR) and social components-allowing subgroup analyses. The neurofeedback subgroup showed the largest effect size (standardized mean difference (SMD)=-0.51, 95 % confidence interval (CI) [-0.88, -0.15], heterogeneity index (I2)=45.85 %, p < 0.05, very low certainty of evidence), followed by the physical exercise/VR subgroup (SMD=-0.40, 95 %CI [-0.76, -0.04], I2=0.00 %, p < 0.05, very low certainty of evidence). Other subgroups, including those with social components or without additional elements, did not show significant effect sizes. The physical exercise/VR subgroup demonstrated small-to-medium effect sizes in both inattention and hyperactivity/impulsivity subscales, whereas the neurofeedback subgroup showed similar effects only in inattention. Trial-level factors, including participant demographics and intervention duration, showed no significant relationship with SMD in meta-regression.

Although inconclusive, synergizing with game dynamics, neurofeedback and physical exercise/VR may enhance effectiveness of computer game-based interventions in addressing pediatric ADHD symptoms. Particularly, interventions with physical exercise/VR have potential to address both inattention and hyperactivity/impulsivity.

Investigation of bone marrow (BM) trephine biopsies and/or clot sections by CD34 immunohistochemistry (IHC) testing has been used by pathologists for several decades, and its clinical value has been well established with QBEND10 being the most frequently used primary antibody (Ab) clone. However, most other parameters related to the IHC protocol as well as the readout vary widely between clinical laboratories and in the published literature. The ICSH Working Group having reviewed the published evidence has established guidelines that will help to harmonize performance and reporting of CD34 IHC on BM biopsies.

The methodology is based on the published "guidelines for guidelines" (GRADE, AGREE) with modifications to the specific laboratory medicine environment and to specific key questions. Review of the published literature resulted in 49 articles relevant to clinical applications of the BM CD34 IHC. Five key questions were addressed including testing indications, technical performance, readout methodology, terminology, and reporting.

A total of 23 guidelines were grouped according to the key questions.

BM CD34 IHC testing is complex with both the protocol and the pathologist's readout requiring validation to ensure reported results are reproducible and accurate. The readout/interpretation must be adapted to a specific purpose of the assay (clinicopathological question) and the type and overall sample quality. Standardized terminology and reporting are essential if CD34 IHC assay is being used for clinical diagnostics.

We conducted a systematic review with pairwise (PMA) and network meta-analyses (NMA) to evaluate sodium-glucose transport protein 2 inhibitor (SGLT2i) effects in patients with both heart failure (HF) and type 2 diabetes mellitus (T2DM). Five databases were searched up to April 15, 2025. Primary outcomes were all-cause mortality (ACM), cardiovascular death (CVD), all-cause hospitalization (ACH), and hospitalization for heart failure (HHF). SGLT2i class effects versus control were assessed via PMA and individual SGLT2i comparative efficacy via NMA plus ranking using p-scores. Seventeen randomized controlled trials (n = 17,809) were included. Arms included canagliflozin (n = 2), dapagliflozin (n = 6), empagliflozin (n = 6), ertugliflozin (n = 1), ipragliflozin (n = 1), sotagliflozin (n = 1), placebo (n = 13), and standard of care (n = 4). Compared to control, SGLT2i significantly reduced ACM (HR 0.87, 95 %CI 0.78 to 0.98, low quality of evidence [QoE]), ACH (HR 0.74, 95 %CI 0.62 to 0.88, high QoE), and HHF (HR 0.70, 95 %CI 0.63 to 0.77, low QoE); but not CVD (HR 0.87, 95 %CI 0.76 to 1.00, very low QoE). Canagliflozin ranked highest in decreasing ACM (p-score = 0.86), CVD (p-score = 0.82), and HHF (p-score = 0.88). In patients with HF and T2DM, SGLT2i class effects include ACM, ACH, and HHF reduction. Among SGLT2i, canagliflozin showed greatest ACM, CVD, and HHF benefit.

Open water recreation (e.g. swimming, surfing) is growing in popularity alongside concerns about contracting infections as a result of wastewater (including sewage) and runoff pollution in seas, rivers, lakes, and other bodies of open water. Previous systematic reviews have found evidence for a positive association between exposure to open water and infection. However, these syntheses focus on comparisons of recreational water users and non-recreational water users, and make concessions on key stages of the systematic review process. This limits their ability to summarise the evidence for an effect of exposure to pollution, specifically.

We present a peer-reviewed protocol for a systematic review and meta-analysis of exposure to wastewater and runoff pollution and infection in recreational open water users in the Global North. Eligible studies must contain at least two groups of recreational water users known or suspected to have been exposed to distinct levels of pollution, with some estimate of cases of infection in each group. These studies will be obtained via searches of bibliographic databases (MEDLINE, Web of Science Core Collection, Environment Complete, and Global Health), grey literature sources, and supplementary search methods. Risk of bias in these studies will be assessed using Cochrane's ROBINS-E and RoB 2 tools. Studies' results will be qualitatively and quantitatively synthesised, following and reporting to contemporary standards and guidelines (e.g. PRISMA, SWiM). The results of the review will be summarised with a GRADE certainty assessment of the evidence for different types of infections, presented in a Summary of Findings table.

To evaluate the effect of various doses of intra articular corticosteroid injection (IACI) on pain reduction in knee osteoarthritis when compared with normal saline and perform a between-dose comparison.

A systematic review with meta-analysis was conducted searching four databases until April 2024. RCTs comparing the effect of IACI with normal saline on pain relief in knee osteoarthritis were included. The different doses were pooled into three categories: low (< 40 mg methylprednisolone equivalent), usual (40 mg), or high dose (> 40 mg). Their effect compared to normal saline was evaluated at very short (VST, 1-3 weeks), short (ST, 4-8 weeks) and middle term (MT, 10-16 weeks). A multivariate analysis carried out the influence of dosage on pain relief, at each time point. The Jadad scale was used to assess risks of bias and GRADE for certainty of evidence.

Eleven studies were included in the meta-analyses (n = 1125 patients). Low dose was significantly superior to normal saline in the VST, but not in the ST (low-quality evidence). No data were available for the MT. The usual dose was significantly superior to normal saline in the ST, but not in the VST and MT (moderate-quality evidence). A high dose was significantly superior to normal saline in the ST and MT (low-quality evidence). Multivariate analysis showed that the dose significantly influenced pain reduction at ST and MT, but not in the VST (low-quality evidence).

The dose of IACI doesn't influence pain reduction in the peak effect, but a higher dose seems to have a more prolonged effect.

Non-invasive brain stimulation (NIBS) techniques have emerged as a promising non-pharmacological adjunct to neurorehabilitation. Children with Cerebral Palsy (CP) exhibit altered cortical excitability, and while CP remains incurable, physiotherapy combined with other interventions is essential for managing motor dysfunction. Although some studies have examined NIBS using various stimulation parameters, there is limited evidence regarding its effects on the lower extremities and optimal administration protocols. This review aims to evaluate the effectiveness of NIBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), for the treatment of motor function in spastic cerebral palsy, specifically in the lower extremity. A systematic search will be conducted in databases including MEDLINE, CINAHL Plus, EMBASE, Scopus, ISI Web of Science, and the Cochrane Central Register of Controlled Trials. The search strategy will follow the PICO framework (Participants, Intervention, Comparison, Outcomes), focusing on randomized controlled trials (RCTs). Two independent reviewers will manage screening, selection, data extraction, risk of bias assessment, and grading of evidence. This review will provide key insights into the effectiveness of NIBS for lower-extremity function in children with spastic CP, guiding future research and clinical applications.

One of the main causes of chronic wounds is diabetes mellitus (DM), a metabolic disease characterized by chronic hyperglycemia. In this context, hydrogels have been used as a promising treatment for stimulating tissue ingrowth and healing in these injuries. This systematic review aimed to evaluate the findings of studies that investigated the effects of injectable hydrogels of various origins on skin wound healing using in vivo experimental models in diabetic rats.

This review was conducted in March 2023 using two databases, PubMed and Scopus, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines and the SYRCLE (Systematic Review Centre for Laboratory Animal Experimentation). The following Medical Subject Headings (MeSH) descriptors were used: "hydrogels," "injectable," "in vivo," "diabetes mellitus," and "skin wound dressing."

After the eligibility assessment, 12 studies were selected and analyzed from an initial 95 articles identified across databases. The studies demonstrated that a variety of injectable hydrogels showed biocompatibility and bioactivity, effectively interacting with skin tissue in diabetic wound models. These hydrogels were assessed for their compositions, structural properties, and in vivo effects on wound closure, inflammation reduction, and collagen deposition. Also, immunofluorescence analyses revealed increased expression of neoangiogenesis markers and reduced inflammatory factors in treated groups, highlighting the hydrogels potential for enhancing skin healing in diabetic wounds.

Injectable hydrogels show significant potential as an effective treatment for diabetic skin wounds, though further clinical studies are needed to fully assess their biological performance.

Physical activity interventions positively influence executive functions in both the general population and individuals with ADHD. However, there is limited research focusing on school-aged children, who have the highest ADHD diagnosis rates. This study aims to provide targeted intervention strategies for improving executive function in this population, offering a practical reference for selecting specific exercise types when designing interventions for children with ADHD.

A systematic search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant RCTs up to September 2023. Two independent reviewers handled literature screening, data extraction, and quality assessment. Stata 15.1 software was used for the meta-analysis.

The meta-analysis included 19 studies, revealing that physical activity interventions significantly improved executive functions in school-aged children with ADHD. Cognitive flexibility (SMD = 0.70, 95 % CI: 0.09, 1.31) and working memory (SMD = 0.74, 95 % CI: 0.20, 1.28) showed moderate to large effects, while inhibition switching had a small to medium effect (SMD = -0.35, 95 % CI: -0.74, 0.03). Subgroup analysis indicated that cognitively engaging exercises were more effective, with intervention outcomes moderated by duration, frequency, and length.

Inconsistent measurement tools among the included studies may introduce biases.

Physical activity interventions are effective in enhancing executive functions in school-aged children with ADHD. Cognitively engaging exercises show the most promise, especially when tailored by intervention duration, frequency, and length.

To assess the evidence about the correlation between objective and subjective methods for evaluating dental anxiety.

Eligibility criteria were defined as follows: Patients (P): individuals in the dental care context; Index test (I): subjective methods; Reference test (R): objective methods; Outcome (O): correlation between methods to dental anxiety evaluation. Searches were conducted in 7 databases and grey literature up to November 2023, without language or date restrictions. The QUADAS-2 tool was employed to evaluate Risk of bias. A random-effects meta-analysis was performed to calculate pooled correlation coefficients between methods on the basis of the objective method analyzed. The GRADE approach was utilized to assess evidence certainty.

A total of 29 studies, with 1891 participants aged 3 to 82 years, were included, with 22 studies participating in the meta-analysis. The Risk of bias was mostly "unclear" due to inadequate methodology detail. Weak correlations were observed between subjective methods and heart rate (r 0.15 [0.08, 0.21], P < .001, I2 = 56%) and alpha-amylase (r 0.25 [0.11, 0.38], P < .001, I2 = 43%. Subjective methods showed a moderate correlation with cortisol analysis (r 0.40 [0.33, 0.47] P < .001, I2 = 72%). No other objective method displayed a significant correlation with subjective methods. The certainty of evidence was very low.

The findings can suggest a correlation between the following subjective and objective methods: ACDAS, DAS, MCDAS, MDAS and Cortisol; CFSS-DS, DAS, MCDAS, MDAS and Alpha-amylase; and DAS, DAS-R, MDAS, S-DAI, Venham Picture Anxiety, Venham Picture Test and Heart rate. Nonetheless, these results lack conclusiveness due to their very low certainty of evidence.

PROSPERO database registration number CRD42022298589.

Rapid sequence intubation (RSI) is a critical procedure in emergency and intensive care settings. Etomidate has been favored for its hemodynamic stability; however, concerns about adrenal insufficiency have prompted interest in ketamine as an alternative induction agent. This systematic review and meta-analysis aimed to compare the effects of etomidate vs ketamine on 30-day survival and other clinical outcomes in critically ill patients undergoing in-hospital RSI. A comprehensive literature search was conducted until 1 November 2024, across PubMed, Embase, Web of Science, Cochrane databases, and clinical trial registries. Eligible studies included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) assessing etomidate vs ketamine for RSI. The primary outcome was 30-day survival. Secondary outcomes encompassed intubation difficulty, post-intubation vasopressor use, cardiovascular collapse, Sequential Organ Failure Assessment score, systemic steroid use, organ support-free days, and adrenal insufficiency. Fourteen studies comprising 23 926 patients (19 288 receiving etomidate; 4638 receiving ketamine) met the inclusion criteria. Pooled analyses of RCTs and CCTs revealed no significant difference in 30-day survival between the two agents [RCTs: odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.68-1.24, P  = 0.58; CCTs: OR = 1.16, 95% CI: 0.92-1.45, P  = 0.58]. Ketamine was associated with a higher requirement for post-intubation vasopressor support (OR = 0.71, 95% CI: 0.53-0.96, P  = 0.03) and an increase in ICU-free days. Etomidate use correlated with a significantly higher incidence of adrenal insufficiency (OR = 2.43, 95% CI: 1.67-3.53, P  < 0.001). No significant differences were observed in intubation difficulty, cardiovascular collapse, or systemic steroid use between the groups. Ketamine and etomidate showed no significant difference in 30-day survival among critically ill patients undergoing RSI. However, etomidate was associated with a higher incidence of adrenal insufficiency, while ketamine required more post-intubation vasopressor support. Provenance and peer review: Not commissioned, externally peer-reviewed.

This umbrella review aims to summarize and synthesize the evidence on risk factors related to intensive care unit-acquired weakness in systematic reviews to create prevention strategies and intervention measures for intensive care unit-acquired weakness.

Eight databases were searched systematically from inception to 1st November 2023. Two researchers independently screened and extracted data based on predefined inclusion and exclusion criteria. The methodological quality, risk of bias and certainty of evidence of reviews included were evaluated using version 2 of the Measurement Tool for Evaluation System Review (AMSTAR-2) and the Risk of Bias in Systematic Reviews (ROBIS), and the Grading of Recommendations Assessment, Development and Evaluation(GRADE) respectively.

This review included 10 systematic reviews, reporting a total of 42 factors and 22 associations with meta-analysis. Overall, among these associations, the methodological and evidence quality of the majority ofstudies was rated as low or extremely low. Most systematic reviews and/or meta-analyses exhibited a high risk of bias.

This umbrella review comprehensively summarized the risk factors related to intensive care unit-acquired weakness and evaluated the methodological quality, risk of bias, and evidence quality of reviews included. Future studies with high-quality research such as cohort studies are needed, to better update and synthesize the risk factors of intensive care unit-acquired weakness.

Inconsistent or even contradictory findings exist among multiple systematic reviews regarding intensive care unit-acquired weakness. The present study offers a comprehensive and readily comprehensible overview of the risk factors linked to intensive care unit-acquired weakness, which is conducive to develop assessment tools for the condition and identify intervention targets.

To develop clinical guidelines on managing wandering in hospitalized persons with dementia (PwD).

The PICO framework and a scoping literature review were used for guideline development. Expert consensus was established using the Delphi method, followed by external and methodological reviews. The guideline was tested for clinical applicability in hospital wards.

The guideline encompasses two topics and 33 recommendations, which were positively rated by external and methodological experts. Among 30 nurses who evaluated its clinical applicability, most recommendations were deemed easy to implement.

The guideline has the potential to enhance care quality for hospitalized PwD. [Journal of Gerontological Nursing, xx(x), xx-xx.].

The "chapeau de gendarme" sign, also known as "ictal pouting," is a distinctive facial expression observed in focal epilepsy, characterized by a turned-down mouth with symmetrical lip and chin contraction. This systematic review investigates its clinical relevance, anatomical origins, and diagnostic value, particularly in presurgical evaluation. The sign is most commonly associated with mesial frontal epilepsy, particularly involving the anterior cingulate cortex (ACC), though moderate evidence links it to a broader network including insulo-opercular and temporo-parietal regions. Variability in semiologic descriptions and the absence of standardized definitions present challenges to its consistent recognition. Focal cortical dysplasia (FCD) was identified as the most frequent pathological substrate linked to this sign, particularly in MRI-positive cases, while nearly half of the reviewed cases were MRI-negative emphasizing the importance of localizing signs such as the "chapeau de gendarme" in cases of suspected FCD. FDG-PET consistently showed hypometabolism in relevant regions, supporting its utility in identifying the epileptogenic zone in MRI-negative cases. The propagation of ictal discharges across interconnected brain regions highlights the involvement of specific network dynamics in generating this semiology. The "chapeau de gendarme" sign holds significant value in presurgical evaluations, particularly as part of a multimodal assessment integrating neuroimaging and electrophysiological data. Despite the descriptive nature of included studies and limited photo documentation, the sign remains a valuable diagnostic tool. Further research is needed to standardize reporting and clarify its role in guiding surgical management, especially in MRI-negative focal epilepsy.

This meta-analysis aimed to compare the acute physiological, physical, and technical demands in soccer players during different sided game formats (1v1 to 10v10). This review included studies on soccer players with a competitive or developmental level, focusing on games with at least one comparison of sided formats. Outcomes assessed included physiological parameters (e.g., heart rate and blood lactate levels), physical demands (e.g., distance and accelerations), and technical actions (e.g., passes). The risk of bias assessment tool for nonrandomized studies of interventions (RoBANS 2) and (Grading of Recommendations, Assessment, Development and Evaluation) were used to evaluate the risk of bias and the certainty of evidence. The search across PubMed, Scopus, and Web of Science identified 2,545 records, of which 72 studies were included. Meta-analyses found that 2v2 and 3v3 formats were more physiologically intense, showing higher perceived exertion and blood lactate levels, with 3v3 also having higher heart rates. The 4v4 and 3v3 formats resulted in greater physical demands compared to the 2v2 format, with increased distances covered at various speeds, although differences were minimal beyond the 4v4 format. Smaller formats promoted ball possession, while the 3v3 format resulted in more successful shots, dribbles, and passes. In conclusion, small-sided games (< 3v3) were more physiologically demanding, mid-sized formats (> 4v4) increased locomotor demands, and smaller formats improved technical skills, although the findings should be interpreted cautiously due to study limitations.

Skeletal Class II malocclusion, often associated with mandibular deficiency, is commonly treated with functional appliances. Precision Wings are a functional appliance that provides an alternative approach by combining mandibular advancement with dental alignment.

This systematic review aimed to evaluate the effectiveness of Precision Wings in treating skeletal Class II malocclusion in growing patients.

Studies assessing the correction of skeletal Class II malocclusion in growing patients treated with Precision Wings were selected according to the PICOS strategy. The PRISMA guidelines were followed.

Unrestricted electronic searches were conducted across seven databases up to February 2025.

The ROBINS-I tool was used to assess the risk of bias (RoB) in non-randomized studies. A random-effects meta-analysis was performed, and the certainty of the evidence was evaluated using the GRADE approach.

Seven studies were included, and data were extracted. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. The findings suggest that Precision Wings may be effective in treating skeletal Class II malocclusion in growing patients through both dental and skeletal changes. Regarding skeletal effects, sagittal changes were limited to the mandible and were of small magnitude, with a reduction in ANB° (MD = -0.81; 95% CI: -1.04 to -0.58; p < 0.001) occurring exclusively due to an increase in SNB° (MD = 0.55; 95% CI: 0.11 to 0.98; p = 0.01), while no significant changes were observed in SNA° (MD = -0.02; 95% CI: -0.42 to 0.38; p = 0.91). The included studies did not report significant vertical effects. Meta-analyses comparing Precision Wings with other functional appliances were not feasible due to the small number of studies evaluating each comparison and the substantial clinical and methodological heterogeneity across the included studies.

Although the available scientific evidence on this topic is limited, treatment with Precision Wings appears to offer minimal clinical improvement in mandibular growth for the correction of skeletal Class II malocclusion. To obtain more conclusive findings, future research should prioritize well-structured randomized clinical trials with standardized treatment protocols, extended follow-ups, and consistent cephalometric assessment methods.

Background/Objectives: The preoperative improvement of patients' functional capacity (prehabilitation) has gained attention in the surgical field, especially for colorectal cancer (CRC) patients. Despite the recognized benefits of prehabilitation programs, patients' motivation to participate in and adhere to them remains a significant challenge. Several studies reported difficulties in recruiting participants and low adherence rates. This systematic review explored patients' motivation for participation and adherence to prehabilitation programs for colorectal cancer surgery. Methods: A systematic search was conducted in the PubMed (MEDLINE), Embase, Cochrane, CINAHL, and Web of Science databases. Eligible studies included clinical trials published from inception until December 2024, written in English or Dutch, describing barriers and/or motivators affecting patient participation and adherence in prehabilitation programs. Results: A total of 89 studies, including 34 randomized controlled trials, were included. In total, 13,383 patients were included, with 7162 in the prehabilitation cohort. Participation rates ranged from 0 to 99.4%, and adherence rates ranged from 15% to 100%. Factors limiting participation included logistical issues and a busy schedule. Professional guidance, peer support, and regaining a sense of control improved adherence. Medical reasons, conflicting obligations, and intensive exercise limited adherence. Conclusions: This systematic review analyzed the current literature on participation and adherence in prehabilitation programs for colorectal cancer surgery patients. Overcoming logistical barriers and patient concerns through flexible, patient-centered approaches may improve participation and adherence. Future research should focus on large-scale randomized controlled trials, diverse healthcare settings, and strategies to enhance engagement with prehabilitation programs.

Medullary thyroid cancer (MTC) is a rare thyroid carcinoma that often presents at an advanced stage. The efficacy of adjuvant postoperative radiotherapy (PORT) in treating MTC remains a topic of debate. We aimed to assess whether PORT enhances survival outcomes in patients with MTC.

We conducted a systematic review of databases, including EMBASE, PubMed, Cochrane Library, and CINAHL to identify relevant studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and local recurrence-free survival (LRFS) were extracted, and pooled analyses were performed using random-effects models.

Ten studies were finally included. Two separate pooled analyses of OS revealed no statistically significant differences between the PORT and observation groups (HR 1.59, 95% CI 0.87-2.92 and HR 1.67, 95% CI 0.92-3.02, including two different National Cancer Database studies with overlapping periods, respectively). Similarly, no significant differences were noted for LRFS (HR 0.90, 95% CI 0.44-1.82; I2 = 0%, p = 0.442).

Although PORT did not demonstrate significant differences in survival outcomes compared to observation, personalized treatment considerations are essential due to heterogeneity among high-risk patients. Further prospective studies are required to define optimal adjuvant treatment strategies for MTC.

In this review, we aimed to determine the effects of dental treatment under general anesthesia on the oral health-related quality of life and dental fear of preschool children.

A comprehensive electronic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted up to July 20, 2023 (updated on April 10, 2024). A manual search and evaluation of the gray literature were also performed. Clinical trials utilizing a before-and-after design to evaluate the effects of dental treatment under general anesthesia (DGA) on oral health-related quality of life (OHRQoL) and dental fear in preschool-aged children were included in this research. To assess study quality, tools specifically designed for "before-after studies without control groups" were employed to determine potential biases. Two independent investigators conducted separate evaluations of the studies' quality assessment processes. A meta-analysis was conducted via the random effects model.

In the final analysis, 13 studies employing a pre-post design were included. The meta-analysis revealed a statistically significant difference in Early Childhood Oral Health Impact Scale (ECOHIS) scores between the pre-evaluation group (n = 1365) and the post-evaluation group (n = 1344) (mean difference [MD] = 9.61, 95% CI: 6.28-12.93; P < 0.00001). However, there was no significant difference in the mean Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) score between the pre-evaluation group (n = 536) and the post-evaluation group (n = 531) (MD = 5.53, 95% CI: -16.48-27.54; P = 0.62).

This study confirmed that children who received dental treatment with general anesthesia experienced improvements in their oral health-related quality of life. However, there is insufficient evidence to support the claim that dental treatment with general anesthesia can effectively alleviate dental fear in children.

Dental treatment with general anesthesia significantly improved the OHRQoL of children. However, methods to improve dental fear in children during this procedure remain to be explored.

During the COVID-19 pandemic, several industries were deemed essential. However, information on infection risk in occupational settings outside of healthcare workers and medical staff (HCWs) remain scarce. Thus, a systematic review with meta-analysis was conducted to compile the risk of infection to SARS-CoV-2 in non-healthcare workers (non-HCWs).

We screened three databases (EMBASE, PubMed, medRχiv) for studies on SARS-CoV-2 infection risk in working population. Several stages of severity (infection, hospitalisation, admission to intensive care unit (ICU), mortality) were eligible. Occupational specifications were harmonised according to the German classification of professions (KldB). All reported risk estimators were considered. Studies were analysed for their risk of bias. Results of random-effects meta-analyses were assessed for their evidence according to GRADE. Subgroup analyses were run for 'outcome', 'comparison group', and 'risk of bias'.

Of 9,081 publications identified, 25 were recognised as eligible, mainly describing the first year of the pandemic. For 20 occupations, we were able to carry out meta-analyses on KldB-4-level by integrating all stages of severity. Nine occupations were identified with a statistically significantly increased risk of infection for SARS-CoV-2, four of which had a relative risk (RR) of > 2: Occupations in meat processing (RR = 3.58 [95%-CI 1.46; 8.77]), occupations in building cleaning services (RR = 2.55 [95%-CI 1.51; 4.31]), occupations in cargo handling (RR = 2.52 [95%-CI 2.27; 2.79]) and cooks (RR = 2.53 [95%-CI 1.75; 3.67]). The certainty of evidence of eight results was found moderate or high.

The first systematic review and meta-analysis of occupational SARS-CoV-2 infection risk in occupations other than HCWs revealed a considerably elevated risk in individual related services as well as in commercial services.

PROSPERO CRD42021297572.

BackgroundAcupuncture, a traditional oriental therapy, is increasingly being adopted globally as a method of complementary intervention for pain relief in patients with fibromyalgia (FM). The aim of this study was to evaluate the effectiveness of acupuncture compared to placebo, pharmacotherapy, or physiotherapy in reducing pain and improving function in patients with FM.MethodsAn electronic search was performed in the MEDLINE, Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases. The eligibility criteria were systematic reviews of clinical trials that compared acupuncture versus control interventions for pain intensity and other clinical outcomes in women with FM.ResultsA total of 10 systematic reviews met the eligibility criteria for the quantitative synthesis. For pain intensity, the mean difference (MD) was -1.30 cm (95% CI = -1.85 to 0.76, p < 0.001). For functional status, the MD was -10.18 points (95% CI = -13.56 to -6.79, p < 0.001). For sleep quality, the MD was 0.46 points 95% CI = -1.85 to 0.76, p < 0.001). For fatigue, the standard mean difference (SMD) was -0.18 (95% CI = -0.86 to 0.51, p = 0.55). For depression, the MD was -6.28 points (95% CI = -9.80 to -2.76, p = 0.0005). Most of the differences were in favor of acupuncture, except for sleep quality.ConclusionCompared to pharmacotherapy and physiotherapy interventions, acupuncture showed statistically significant differences in pain intensity, functional status, and depression symptoms; however, all differences did not reach the minimum threshold to be considered clinically important in patients with FM. The quality of evidence was low to very low according to GRADE ratings.

Photobiomodulation can alleviate the severity or delay the development of cognitive impairment through early prevention and intervention. This systematic review summarizes the effectiveness of photobiomodulation in improving cognitive function across various populations. Clinical randomized controlled trials from the establishment of the database to October 2024 were searched in PubMed, Web of Science, EMBASE, and the Cochrane Library according to PRISMA guidelines. Trials comparing the effects of PBM treatment with placebo or sham stimulation on cognitive function in healthy adults or subjects with cognitive impairment were included. Two independent researchers conducted literature screening, data extraction, and quality assessment of the included studies. Meta-analyses were performed using random effects models with Review Manager V.5.4 software. The methodological quality of the studies was evaluated using the Cochrane Risk of Bias tool. Sensitivity analyses were performed using Stata V.15.1 software. A total of 24 randomized trials involving 820 participants met the inclusion criteria. Compared with the control group, PBM treatment showed significant benefits for subjects in terms of global cognitive function (SMD = 0.66, 95% CI: 0.23 to 1.08, P = 0.003), working memory span (SMD = 1.41, 95% CI: 0.78 to 2.04, P < 0.0001), attention (SMD = -1.15, 95% CI: -2.05 to -0.24, P = 0.01) and the reaction time of executive function (SMD = -1.10, 95% CI: -1.86 to -0.33, P = 0.005) aspects. In the subgroup analyses, with the exception of no differences in both reaction time of working memory and accuracy of executive function, cognitive impaired subjects showed some improvement in other all cognitive domains (attention test only for healthy subjects), while healthy subjects showed an insignificant improvement in reaction time of executive function. This meta-analysis found that PBM treatment positively impacts global cognitive function, working memory, and executive function in persons with cognitive impairment, and partially improved global cognitive function, working memory and attention in the healthy population. However, this finding should be treated with caution due to the heterogeneity and limitations of the studies. Registration number: CRD42024552832. Registration data: 2024/06/10.

This fifth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to systematic reviews, clinical practice guidelines, and health technology assessments and addresses issues of indirect evidence. Guideline developers and health technology assessment practitioners must carefully specify the population, intervention, comparison, and outcome (PICO)—their target PICO—and consider the extent to which the best available evidence matches their target. When target and study PICOs differ substantially, studies provide indirect evidence and Core GRADE users may rate down the certainty of evidence as a result of this indirectness. Whether examining studies from a search for direct evidence or a deliberate search for indirect evidence, for each substantial difference between target and study PICO Core GRADE users must judge the likelihood that magnitude of effects will differ substantially. The greater the likelihood of substantial differences the more advisable rating down for indirectness.