Develop a proposal to involve people living with rare and complex conditions in the development of clinical practice guidelines (CPGs) based on a systematic review of qualitative literature.

A systematic review was conducted using medical subject heading-term and text-word search strategies to identify qualitative literature on patient living with rare diseases (PLWRD) involvement during CPG development and in research studies. Databases were searched for literature in English or Spanish, published until April 2024.

64 publications were included in this review, underscoring the critical importance of PLWRD involvement in the CPGs development. The studies reported different strategies to facilitate the involvement of patients and collect relevant information from the patient community. The Guideline Development Group and the Core Writing Group should include representatives of the patient community, closely communicating with a patient advisory group to facilitate a broader patient perspective. Patient representatives should be engaged throughout all stages of CPG development, from defining the scope to implementation.

This proposal offers a framework for actively involve PLWRD throughout the CPGs development process, aiming to produce more inclusive and practical recommendations that better reflect real-world patient needs.

To systematically review hospital length of stay (LOS) associated with falls, pressure ulcers, central line-associated bloodstream infections, and surgical site infections and their potential differences before and after the implementation of the hospital-acquired condition (HAC) reduction program (HACRP).

We searched PubMed, Embase, and Cochrane databases from January 1, 2000, to May 26, 2024, for studies examining LOS and health care costs in patients with any of the 4 HACs. Studies included prospective and retrospective cohorts and case-control designs across various clinical settings.

Fifty studies involving 45,080,370 patients admitted for medical and surgical conditions met the inclusion criteria, with 1,939,151 patients experiencing 1 or more HACs. Length of stay increased by an average of 5.2 days for falls, 12.9 days for pressure ulcers, 22.1 days for central line-associated bloodstream infections, and 7.9 days for surgical site infections. After HACRP implementation, LOS for falls increased by 4.9 days, whereas LOS for pressure ulcers decreased by 39.1 days.

This systematic review presents detailed data on excess LOS for 4 selected HACs across medical, surgical, intensive care unit, and rehabilitation settings over the past 25 years. The varying impact of HACRP on different HACs highlights the need for targeted prevention strategies.

Alzheimer's disease (AD) remains a progressive neurodegenerative disease with no cure. Treatment of AD relies on administering drugs that only subside the symptoms. In recent studies, mesenchymal stem cell (MSC)-exosomes have been marked to possess therapeutic potential for treating AD. This study aims to systematically review and analyse findings that focus on the isolation, characterisation, and sources of MSC-derived exosomes used to unravel the therapeutic potential of these exosomes targeting AD using in vitro and in vivo models. It is hypothesised that MSC-exosomes exhibit high therapeutic potential for AD treatment by exerting various modes of action. PubMed, Scopus, and Medline were used to find relevant published works from January 2016 until December 2020, using assigned keywords including "Alzheimer's disease", "secretome", and "exosomes". Only research articles meeting the predefined inclusion/exclusion criteria were selected and analysed. The risk of bias was assessed using the Office of Health Assessment and Translation tool (OHAT). A total of 17 eligible in vivo and in vitro studies were included in this review. Bone marrow-derived stem cells (BMSCs) were the most used source for exosome isolation, even though studies on exosomes from adipose-derived stem cells (ADSCs) and human umbilical cord stem cells (HUCSCs) provide more information on the characteristics. When the risk of bias was assessed, the studies presented various levels of biases. Notably, the in vitro and in vivo studies revealed neuroprotective properties of MSC-exosomes through different modes of action to alleviate AD pathology. Our review discovered that most MSC exosomes could degrade Aβ plaques, enhance neurogenesis, extenuate neuroinflammatory response through microglial activation, regulate apoptosis and reduce oxidative stress. Delivery of exosomal micro-RNAs was also found to reduce neuroinflammation. Findings from this review provided convincing systematic evidence highlighting the therapeutic properties of MSC-derived exosomes as a prospective source for cell-free (acellular) therapy in treating AD.

Schizophrenia (SCZ) is a complex neuropsychiatric disorder with unclear pathogenesis, limiting advances in early diagnosis and targeted interventions. Increasing evidence suggests that the gut microbiome contributed to SCZ pathophysiology, yet comprehensive characterization across illness stages remains lacking. This meta-analysis aimed to characterize gut microbial alterations across the SCZ spectrum disorder, including individuals at ultra-high risk for psychosis, first-episode psychosis (FEP) and chronic SCZ patients. A systematic search of 10 databases identified 91 case-control studies. Gut microbial outcome measures included relative abundance, alpha and beta diversity. Review Manager and R were used to analyze the data. The results showed that patients with SCZ exhibited significantly reduced alpha diversity, particularly in Shannon, Chao1, Observe and Evenness indices, compared to healthy controls. Beta diversity also differed significantly, with 88.5 % of studies reporting distinct microbial profiles across SCZ stages. Quantitative analysis revealed significantly increased relative abundance of Bacteroides and a decrease abundance of Bifidobacterium and Lactobacilli in FEP patients compared to healthy controls. Qualitative analysis further showed increasing abundance in Lactobacillus, Prevotella and Collinsella, but decreasing abundance in Faecalibacterium, Butyricicoccus, and Blautia in SCZ. Bifidobacterium exhibited stage-specific changes, decreasing in first-episode psychosis but increasing in chronic stages, while Bacteroides followed an opposite trajectory. Notably, Lactobacillus demonstrated an early upward tractor in high-risk individuals, persisting to chronic stages. This meta-analysis identified dynamic and consistent alterations in the gut microbial across the SCZ spectrum. These findings implicated the potentials of gut microbes as early indicators for identification and intervention of SCZ.

Background: This qualitative systematic review provides an overview of existing studies on the desire for parenthood of people with intellectual disabilities. Method: The scientific studies were identified following the Prisma protocol on 18 databases using keywords relating to sexuality and parenting. Results: Sixteen studies have been included and three categories identified: the obstacles and motivations to becoming a parent; parents' decision making during pregnancy; and the social construction of a parental identity. The results from these studies show that people with intellectual disabilities have a genuine desire for children, which is repressed because of an unfavorable social context. Conclusion: Further clinical and participatory research is needed to better understand the singular modes of expression of people's intimate desires and how to better accompany them on this issue.

Study DesignSystematic review and meta-analysis.ObjectiveThis meta-analysis aimed to compare hybrid surgery (HS) and two-level anterior cervical discectomy and fusion (ACDF) in the treatment of consecutive two-level cervical degenerative disc disease (CDDD).MethodsComprehensive searches were conducted in PubMed, Embase, and Web of Science. Extracted data from the selected studies included operative time, intra-operative blood loss, C2-C7 range of motion (C2-C7 ROM), superior adjacent segment range of motion (SAS ROM), inferior adjacent segment range of motion (IAS ROM), complication incidence, neck disability index (NDI) score, Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score. Meta-analysis was conducted using RevMan 5.3.ResultsA total of 626 patients from 11 studies who underwent either HS or two-level ACDF for CDDD were analyzed. Compared to ACDF in the non-ROI-C cage group, HS better preserved post-operative and final follow-up C2-C7 ROM (post-operation: MD 10.08, 95% CI 6.58 to 13.58, P < 0.01; final follow-up: MD 7.62, 95% CI 5.83 to 9.42, P < 0.01). HS significantly reduced post-operative and final follow-up SAS ROM and IAS ROM at the final follow-up. Additionally, HS resulted in less intraoperative blood loss than ACDF when blood loss reached 90 mL or more. Analysis of functional scores (NDI, JOA, and VAS), operative time, and complication rates showed no significant differences between HS and ACDF.ConclusionHS achieved better radiographic outcomes compared to two-level ACDF, with comparable clinical outcomes, reduced intraoperative blood loss, and a similar complication rate. However, further high-quality randomized controlled trials are needed.

BackgroundChronic non-specific neck pain (CNSNP) is a highly prevalent musculoskeletal disorder associated with significant disability, resulting in growing recourse to healthcare providers, huge cost for society and a great number of workdays lost.ObjectiveBy this systematic review and metanalysis we aimed to assess the effects of different physical therapy techniques in patients with CNSNP.MethodsPubMed, Scopus, and Web of Science databases were regularly used to search for articles published from 1st January 2010 until 31st January 2024. All RCTs were assessed for eligibility, including studies on: patients with diagnosis of CNSNP; physical therapy approaches such as manual therapy (MT) and therapeutic exercise (TE); waiting list, sham treatments, as comparison; Visual Analogue Scale, Numerical Rating Scale, Numerical Pain Rating Scale, and Numerical Pain Scale, as outcomes.ResultsAt the end of the search, 14025 studies were identified. After the removal of duplicates, 10,852 were considered eligible according to title and abstract screening, while 10,557 papers were excluded after this process. Therefore; a total of 11 RCTs were included in this systematic review. A decrease of pain intensity was observed in all groups, albeit in patients being treated with TE and MT. Besides this, the combination of TE and MT demonstrated a 91% of probability to be the best choice in patients with CNSNP at the first visit. Only the combination of TE plus MT/cognitive behavioral therapy and MT as a single treatment showed a reduction in pain score. Overall, 3 studies (27.2%) showed a low risk of bias, 6 (54.5%) showed some concerns in bias assessment, and 2 (19%) a high risk of bias.ConclusionCollectively, the findings of this systematic review showed that MT and TE might be considered as effective rehabilitation approaches for treatment of pain in patients with CNSNP.

Along with discussing bibliometric analyses' limitations and potential biases, this paper addresses the growing need for comprehensive guidelines in evaluating bibliometric research by providing systematic frameworks for both peer reviewers and readers. While numerous publications provide guidance on implementing bibliometric methods, there is a notable lack of frameworks for assessing such research, particularly regarding performance analysis and science mapping. Drawing from an extensive review of bibliometric practices and methodological literature, this paper develops structured evaluation frameworks that address the complexity of modern bibliometric analysis, introducing the VALOR framework (Verification, Alignment, Logging, Overview, Reproducibility) for assessing multi-source bibliometric studies. The paper's key contributions include comprehensive guidelines for evaluating data selection, cleaning, and analysis processes; specific criteria for assessing conceptual, intellectual, and social structure analyses; and practical guidance for integrating performance analysis with science mapping results. By providing structured frameworks for reviewers and practical guidelines for readers to interpret and apply bibliometric insights, this work enhances the rigor of bibliometric research evaluation while supporting more effective peer review processes and research planning. The paper also discusses potential areas for further development, including the integration of qualitative analysis with bibliometric data and the advancement of field-normalized metrics, ultimately aiming to support authors, reviewers, and readers in navigating the complexities of bibliometrics and enhancing the meaningfulness of bibliometric research.

Computer-assisted implant placement has been reported to provide better accuracy, particularly in complex situations, while noncomputer-assisted approaches remain effective for more straightforward procedures. However, comprehensive evidence comparing these approaches across various clinical scenarios is limited. Evaluating factors such as cost-effectiveness, edentulous span, and clinician expertise is essential for optimizing treatment planning.

The purpose of this systematic review and meta-analysis was to compare the accuracy of dental implant placement between computer-assisted and noncomputer-assisted workflows.

A systematic search of the PubMed, Embase, and Scopus databases (up to August 2024) was conducted using keywords related to surgery, computer-assisted techniques, and dental implants. The primary outcomes were angular, 3-dimensional (3D)-coronal, and 3D-apical deviations. Studies were selected based on predefined inclusion and exclusion criteria, and quantitative meta-analysis was performed.

Forty-five studies met the inclusion criteria. In clinical studies, meta-analysis showed a mean difference (MD) of 0.65 mm (95% CI: 0.56 to 0.74; P<.001) for global coronal deviation, 1.10 mm (95% CI: 0.95 to 1.20; P<.001) for global apical deviation, and 3.87 degree (95% CI: 3.31 to 4.44; P<.001) for angular deviation, favoring the computer-assisted implant workflow, based on 22 studies. In in vitro studies, the MD was 0.45 (95% CI: 0.36 to 0.54; P<.001) for global coronal deviation, 0.63 mm (95% CI: 0.50 to 0.76; P<.001) for global apical deviation, and 3.60 degree (95% CI: 2.66 to 4.54; P<.001) for angular deviation, favoring the computer-assisted implant workflow, with data from 23 studies. Among the navigation systems, robotic-assisted implant surgery (r-CAIS) achieved the highest clinical accuracy across all metrics compared with noncomputer-assisted techniques.

Overall, computer-assisted implant workflows significantly improved the accuracy of implant placement, with r-CAIS demonstrating the highest accuracy in clinical scenarios. However, factors such as cost-effectiveness, edentulous span, and clinician expertise must be considered, as conventional methods remain suitable alternatives in certain straightforward situations. These findings highlight the importance of tailored treatment planning to optimize the outcomes of implant-supported prostheses.

Aim: Poor outcomes in advanced hepatocellular carcinoma (HCC) coupled with potential significant treatment side effects underpin a strong rationale to assess health-related quality of life (HRQOL) in those treated with systemic therapies. This study is aimed at quantifying the effect of systemic therapies on HRQOL outcomes in HCC patients when compared to baseline or placebo, other systemic therapies, and transarterial radioembolisation (TARE). Methods: In May 2024, two independent reviewers searched PubMed, EMBASE, and Google Scholar for studies comparing postsystemic therapy HRQOL scores in adult patients with HCC to baseline or placebo, other systemic therapies, or to TARE. Narrative synthesis was used to synthesise results. Risk of bias was assessed using RoB 2 and ROBINS-I. This review was structured according to PRISMA guidelines and was prospectively registered in the PROSPERO register (CRD42024521699). Results: Twenty-nine studies with 10,472 patients using eight HRQOL instruments were included. Compared to baseline, patients on atezolizumab/bevacizumab and sorafenib both experienced significant declines in HRQOL, and lenvatinib nonsignificantly decreased HRQOL. HRQOL remained unchanged in patients on pembrolizumab or nivolumab. Atezolizumab/bevacizumab and lenvatinib both significantly delayed HRQOL deterioration compared to sorafenib. Compared to TARE, atezolizumab/bevacizumab delayed time-to-deterioration in HRQOL, whereas sorafenib had significantly worse HRQOL. Conclusion: Despite worsening HRQOL outcomes compared to baseline, the first-line agents atezolizumab/bevacizumab and lenvatinib had superior HRQOL outcomes in comparison to sorafenib. Sorafenib significantly worsened HRQOL compared to TARE. As the majority of included studies included sorafenib, which has been largely superseded by newer therapies, further trials evaluating HRQOL with these newer therapies are required.

ObjectiveTo analyse the evidence of the effectiveness of long-acting injection buprenorphine (LAI-B) in the management of opioid use disorder (OUD).MethodDatabases were searched for studies reporting on the effectiveness of LAI-B for the treatment of OUD. Risk of bias was assessed, and a narrative synthesis of data was presented. The study adhered to PRISMA guidelines and was registered with PROSPERO (CRD42023396033).ResultsEighteen studies were included in the final review: two double-blind randomised control trials, two open-label randomised control trials, two retrospective cohort studies, one non-controlled pilot study, and eleven observational studies. In comparative trials, LAI-B was superior to placebo and superior or non-inferior to treatment as usual. LAI-B was positively associated with improvements in abstinence rates and patient-centred outcomes. There was limited data on the long-term effects of continuous LAI-B prescription.ConclusionLAI-B is an effective treatment for OUD with advantages over existing forms of treatment. Patients reported high levels of medication satisfaction and there were no significant safety concerns. This review highlights the need for future research on long-term effectiveness outcomes, with participants of more varied demographics and psychiatric comorbidity, which is more reflective of the OUD population seen in community clinical settings.

Penetrating carotid artery injuries (CAIs) are rare with high morbidity and mortality. We aimed to perform a systematic review of the published literature to evaluate the work-up and management of penetrating CAI.

Studies of acute management of adult trauma patients with penetrating common or internal CAIs on MEDLINE or EMBASE from 1946 through July 2024 were included following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement methodology. Exclusion criteria was case series with <5 patients, review articles, animal studies, cadaver studies, non-English language, and age<18. Risk of bias was assessed with Oxford Level of Evidence and findings evaluated via Grading of Recommendations, Assessment, Development, and Evaluations.

Our systematic review identified 4,737 studies, of which 35 were included. Preoperative evaluation transitioned to screening computed tomography angiography of the neck in the absence of hard signs. Management now includes endovascular and nonoperative in select cases: nonoperative for some small intraluminal injuries and stenting or embolization for surgically inaccessible lesions. Repair or revascularization was preferred in all but neurologically devastated comatose patients, in which, ligation was deemed acceptable. Temporary intravascular shunting with a takeback for definitive revascularization was associated with a 100% stroke or death. Postoperative antiplatelet or anticoagulation therapy and follow-up was nonstandardized with a shift toward antiplatelet therapy for all injuries described more recently.

Penetrating CAI remains challenging with a shift toward less invasive initial workup with computed tomography angiography and management including endovascular and nonoperative in select cases. Temporary intravascular shunting with delayed revascularization and ligation were both associated with poor outcomes. Postoperative antiplatelet therapy has become increasingly common and postoperative surveillance is not standardized.

The aim of this systematic review with meta-analysis was to evaluate the efficacy of conservative interventions in pain relief in patients with intracapsular temporomandibular disorders (TMD).

PubMed, Scopus, and Web of Science were systematically searched until January 1st, 2022 to identify randomized controlled trials (RCTs) presenting patients with diagnosis of intracapsular TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), conservative approaches as interventions, and pain intensity as outcome.

Out of 3372 papers, 13 RCTs were included, with 844 study participants. Most of them (n = 7) investigated the efficacy of splint appliance. Meta-analysis revealed that rehabilitative interventions had a significant overall effect size of 0.75 [0.17, 1.34], reporting splint appliance and laser therapy as significantly effective treatments.

Findings of this systematic review with network meta-analysis suggested that conservative approaches might be effective in pain relief of intracapsular TMD patients.

Protein is essential for optimal growth, function, and maintenance of health. Its impact on bone, kidney health, and sarcopenia progression remains debated.

This review examines the association between dietary protein intake and the risk of bone disease, kidney disease, and sarcopenia to inform protein dietary reference intake updates.

We searched Medline, EMBASE, AGRICOLA, and Scopus from January 2000 to May 2024, supplemented by citation searching for relevant reviews and original research. We included randomized and nonrandomized controlled trials, prospective cohort studies, and nested case-control studies examining dietary protein intake without exercise. We assessed the risk of bias (RoB), performed a qualitative synthesis of low to moderate RoB studies, and evaluated the strength of evidence.

Of 82 articles detailing 81 unique studies, only 13 were assessed with low to moderate RoB and synthesized, comprising bone disease [4 randomized controlled trials (RCTs) and 1 prospective cohort study], kidney disease (1 RCT), and sarcopenia (9 RCTs). The overarching evidence was insufficient, largely due to the limited number of low to moderate RoB studies, the diversity of dietary protein interventions, and the broad range of outcomes, which complicated synthesis and comparison. Notably, sparse literature addressed children and adolescents, and only a single study each examined the impact of dietary protein intake on bone disease risk (yielding mixed findings) in these populations and on kidney disease risk (showing no significant effects) in adults. The findings on the impact of protein intake on bone disease in adults and sarcopenia risk were mixed; some studies showed no effect, whereas others indicated benefits.

The evidence since 2000 on associations between dietary protein intake and the risks of bone disease, kidney disease, and sarcopenia is unclear, indicating a need for more rigorous research.This trial was registered at PROSPERO as CRD42023446621.

Breast milk is a complete and nutritious food for newborns and infants, but it may be contaminated with Aflatoxin M1 (AFM1), which endangers consumers' health. Several studies from various regions have determined the concentration and prevalence of AFM1 in mother milk. In this study, an attempt was made to meta-analyze the concentration and prevalence of AFM1 and estimate the health risk of infants. The concentration and prevalence of AFM1 in the countries subgroup were meta-analyzed in the random effects model (REM), and also the effect over time on the prevalence of AFM1 was determined by meta-regression. Finally, the human risk in infants was estimated via the margin of exposure (MOES) in different countries. The five countries with the highest prevalence of AFM1 in mother milk were observed in Jordan (100.00), Tanzania (100.00), Mexico (97.00%), Lebanon (93.69%), and Colombia (90.00%). The pooled prevalence of AFM1 in mother milk was 54.48%, 95% CI (42.99-65.73). The five countries with the highest concentration of AFM1 in mother milk were observed: Egypt (570 µg/l), Sudan (413 µg/l), Cameroon (315.00 µg/l), Serbia (175 µg/l), and Tanzania (70 µg/l). The pooled prevalence of AFM1 in mother milk was 6.00, 95% CI (5.80-6.90(. Except for Egypt, infants in other countries are at an acceptable health risk (MOEs > 10,000). Considering the unacceptable risk due to the consumption of milk containing AFM1 in Egypt, it is suggested that programs be carried out to control the quality of mother milk.

Hyperpartisan news consists of articles with strong biases that support specific political parties. The spread of such news increases polarization among readers, which threatens social unity and democratic stability. Automated tools can help identify hyperpartisan news in the daily flood of articles, offering a way to tackle these problems. With recent advances in machine learning and deep learning, there are now more methods available to address this issue. This literature review collects and organizes the different methods used in previous studies on hyperpartisan news detection. Using the PRISMA methodology, we reviewed and systematized approaches and datasets from 81 articles published from January 2015 to 2024. Our analysis includes several steps: differentiating hyperpartisan news detection from similar tasks, identifying text sources, labeling methods, and evaluating models. We found some key gaps: there is no clear definition of hyperpartisanship in Computer Science, and most datasets are in English, highlighting the need for more datasets in minority languages. Moreover, the tendency is that deep learning models perform better than traditional machine learning, but Large Language Models' (LLMs) capacities in this domain have been limitedly studied. This paper is the first to systematically review hyperpartisan news detection, laying a solid groundwork for future research.

This study aimed to investigate the concentration of potentially toxic elements (PTEs) such as cadmium (Cd), arsenic (As), lead (Pb), mercury (Hg), and nickel (Ni) in river sediments across China. Additionally, it performed a non-dietary risk assessment for the exposed population. We searched international databases, including Web of Science, PubMed, Scopus, and Google Scholar (for gray literature), covering the period from January 1, 2010, to February 30, 2023. Ultimately, we included 136 papers comprising 190 studies or data reports. Our findings revealed that the highest Arsenic concentrations were found in the Mawei River, Xiangjiang River, and Fuyang River sediments. The highest Lead concentrations were detected in the North River sediment, and the Yangtze, Xiangjiang, and North Rivers showed the most significant Cadmium levels. The rank order of PTEs based on the percentage of significant non-carcinogenic risk (toxicity hazard quotient, THQ > 1) in adults was as follows: arsenic (87%) > lead (29%) > cadmium (24%) > mercury (18%) > nickel (4%). In adolescents, the ranking was as follows: arsenic (95%) > lead (84%) > cadmium (62%) > mercury (28%) > nickel (18%). Our findings indicate that the non-carcinogenic risk in most of the studied locations in China is unacceptably high due to arsenic, lead, and cadmium (THQ > 1). Furthermore, the carcinogenic risk of arsenic in the majority of the studied areas (99%) was also deemed unacceptable (cancer risk > 1E-6). As such, the pollution from toxic elements in the sediments of China's rivers requires urgent attention.

Long-term exposure to potentially toxic elements (PTEs) increases carcinogenic and non-carcinogenic risks in the exposed population. The current study was conducted with the aims of meta-analysis concentrations of PTEs including Arsenic (As), Cadmium (Cd), Lead (Pb), Mercury (Hg), Nickel (Ni) and Copper (Cu) in the water resources and human health risk assessment for adult males and female consumers in China. Search was performed in international databases including Web of Science, Scopus, PubMed, Embase and Google Scholar (gery literature) from January 1, 2005 to April 1, 2024. The concentration of PTEs was meta-analyzed using random effects model in water resources (surface water and groundwater) and location of study (urban and rural locations) subgroups. Human health risk assessment due to PTEs in water from ingestion and dermal contact pathways was estimated using target hazard quintet (THQ) and carcinogenic (CR) in adult males and female consumers in China. One hundred and twenty-six papers with 237 data-reports (n = 13,083) were included in this study. The rank order of PTEs based on pooled concentration was As (12.6530 µg/l) > Cu (11.1810 µg/l)> Ni (2.4950 µg/l) > Pb (2.0660 µg/l) > Cd (0.5370 µg/l) > Hg (0.3600 µg/l). The rank order of PTEs based on percentage studies higher than standard limits was As (28.37 %) > Pb (16.67 %) > Hg (11.86 %) > Ni (9.91 %) > Cd (7.48 %) > Cu (2.38 %). The pooled concentration of Pb, Ni, Hg and Cu in surface water resources was higher than groundwater but concentration of As and Cd in groundwater water was higher than surface water. The rank order of PTEs based on percentage studies with the high non-carcinogenic risk (THQ ≥ 1) for male was As (30.49 %) > Cd (8.09 %)> Hg (6.90 %) > Ni (3.60 %)> Cu (3.39 %) > Pb (2.50 %) and for female, As (29.78 %) > Cd (8.09 %)> Hg (6.90 %) > Cu (3.39 %) > Ni (2.70 %)> Pb (1.25 %). The rank order of PTEs based on percentage studies with high carcinogenic risk (TCR ≥ 1E-4) for male was As (60.28 %) > Cd (33.33 %) and for female, As (56.73 %) > Cd (29.93 %). Therefore, to reduce the carcinogenic and non-carcinogenic risks of PTEs especially As, continuous monitoring and control release of As into water resources through novel approaches is recommended.

Splenic artery embolization (SAE) has emerged as a promising alternative for managing variceal bleeding secondary to portal hypertension (PH). This study aims to elucidate the significance of SAE in managing esophageal variceal bleeding in patients with PH, providing an overview of its efficacy, safety, and role in PH management.

A systematic review and meta-analysis were conducted in accordance with PRISMA standards. EMBASE, PubMed, Scopus, and Web of Science databases were searched from inception until April 14, 2024. Original observational and clinical studies on SAE in managing variceal bleeding due to PH were included. Meta-analyses were performed using a random-effects model, and publication bias was assessed using regression and rank correlation tests for funnel plot asymmetry.

Eighteen studies met the inclusion criteria, encompassing 531 patients. The meta-analysis revealed a significant reduction in variceal bleeding post-SAE (RD = -0.86; 95% CI: -0.97, -0.75; p < 0.001). Complete resolution of varices was observed in 26% of patients (95% CI: 11%, 45%; p = 0.006), and 78% showed improvement in variceal grade (95% CI: 43%, 88%; p < 0.001). SAE significantly increased platelet counts (SMD = 1.15; 95% CI: 0.63, 1.68; p < 0.001). Common complications included post-embolization syndrome, and the overall complication rate was low.

This systematic review and meta-analysis study supports the efficacy and safety of SAE in managing variceal bleeding due to PH, demonstrating significant reductions in bleeding, improvements in variceal grade, and increases in platelet counts.

Malachite Green (MG) is an antibiotic with antifungal activity, which is illegal to use in agriculture due to its mutagenic and teratogenic properties. Several scientific papers have been published on MG in fish. Therefore, an attempt was made to determine the meta-analysis concentration of MG in fish based on countries and types of fish subgroups, as well as the health risks of consumers, using the Monte Carlo simulation (MCS) model. The three countries with the highest concentration of MG were Iran (14.697 µg/kg), Brazil (2.840 µg/kg), and China (2.277 µg/kg). The overall pooled concentration of MG in fish was 3.036 µg/kg, 95%CI (2.860-3.212 µg/kg), and the highest concentration of MG was observed in Pacu fish (6.603 µg/kg). The health risk assessment shows adults in Malaysia, China, and Iran and children in Italy, Spain, Brazil, Malaysia, China, and Iran are at considerable risk (MOE <10,000); hence, carrying out control plans in these countries is recommended.

New types of wheelchairs are being introduced in the market to maximize opportunities for children to participate in meaningful occupations. However, interventions to support the inclusion of children with mobility limitations by using mobility support are desirable as these children continue to experience barriers to community and school participation, happiness, and inclusion. Little is known about the training programs and interventions designed to effectively integrate wheelchair use into the occupations of children with mobility limitations. This rapid review identified 10 studies addressing programs and interventions to equip children with mobility limitations with wheelchair-related skills and competencies. Three overarching themes, including (1) technology-mediated simulation, (2) custom-made wheelchairs, and (3) skills training and exercises, based on the type of intervention were identified. The development, safety, and playfulness of children with mobility limitations are crucial factors when providing wheelchair-related interventions.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, and temporomandibular joints (TMJs) are involved in 39%-78% of patients.

The aim of this systematic review was to assess the effectiveness of conservative approaches in improving TMJ arthritis in children and adolescents affected by JIA.

PubMed, Scopus, and Web of Science were systematically searched from the inception until February 25, 2024, to identify observational studies presenting participants with a diagnosis of JIA affecting the TMJ, rehabilitative approaches for TMJ arthritis as interventions, and clinical or radiological assessment of TMJ arthritis as outcome.

Of 478 papers suitable for title/abstract screening, 13 studies were included. The studies evaluated the effectiveness of intra-articular (IA) corticosteroid (CS) injections, IA infliximab injections, arthrocentesis alone or in combination with IACS injections, occlusal splint, functional appliance, and physiotherapy. The effectiveness of IACS injections was shown in eight studies. IA infliximab injections did not appear to significantly improve TMJ arthritis.

Results of this systematic review suggested that conservative treatments, especially IACS injections, might be effective in improving TMJ arthritis in patients affected by JIA. Further studies with a higher level of evidence and more representative samples should be conducted.

One of the most challenging aspects of treating patients facing primary ovarian insufficiency, especially those eligible for controlled ovarian hyperstimulation (COH), is the assessment of ovarian function and response to stimulatory protocols in terms of the number of oocytes retrieved. The lack of consistency between studies regarding the best parameter for response evaluation necessitates a comprehensive statistical analysis of the most commonly utilized ovarian reserve markers (ORM). This systematic review and meta-analysis aims to establish the optimal metric for assessing ovarian reserve among COH candidates.

The PubMed/MEDLINE, Scopus, and ISI Web of Science databases were searched until July 2024, with no date or language limitations. The Newcastle-Ottawa scale was used to evaluate the validity of anti-Mullerian hormone (AMH), antral follicle count (AFC), follicle-stimulating hormone (FSH), and estradiol (E2) in patients receiving controlled ovarian hyperstimulation. Studies on the diagnostic accuracy of ovarian reserve markers in predicting ovarian response to controlled ovarian hyperstimulation in assisted reproduction technology (ART) candidates were reviewed. The diagnostic odds ratio (DOR) was determined using the Der Simonian-Laird random effects model meta-analysis to assess the likelihood of detecting low or high ovarian responses in COH candidates. Cochran's Q, and I-squared, were used to analyze between-study heterogeneity.

This systematic review and meta-analysis included 26 studies including 17 cohorts, 4 case controls, and 5 cross-sectional studies. AFC and AMH demonstrated significant diagnostic performance compared to FSH and E2 in poor and high response category. AMH slightly outperformed AMH and had the highest logarithm of DOR for detecting poor [2.68 (95% CI 1.90, 3.45)] and high ovarian response [2.76 (95% CI 1.57, 3.95)]. However, it showed a high between-study heterogeneity (I2 = 95.65, Q = 189.65, p < 0.05).

AFC and AMH were the most accurate predictors of poor and high ovarian response to controlled ovarian hyperstimulation. However, further research is needed to develop models assessing the combined impact of AMH and AFC on ovarian response prediction.

PROSPERO CRD42021245380.

Recognizing and appropriately responding to ethical considerations is a crucial element of ethical nursing practice. To mitigate instances of ethical incongruity in healthcare and to promote nurses' comprehension of their professional ethical responsibilities, it is imperative for researchers to accurately evaluate ethical sensitivity. Conducting a systematic review of the available instruments would enable practitioners to determine the most suitable instrument for implementation in the field of nursing.

This review aims to systematically assess the measurement properties of instruments used to measure ethical sensitivity in nursing.

A systematic literature search was conducted in July 2022 in the following electronic databases: Scopus, CINAHL, APAPsycINFO, Embase, Web of Science, and PubMed. Two reviewers independently screened and assessed the studies in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The updated criteria for good measurement properties are used to rate the result of measurement properties, and the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to grade the quality of the summarized evidence.

This review encompasses a total of 29 studies that describe 11 different instruments. Neither cross-cultural validity nor responsiveness was examined in any of the included studies. Whereas the majority of the instruments were conducted with at least some type of validity assessment, nearly all of the reliability results rated were indeterminate. Two instruments were recommended, the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units. It is recommended that new self-administration instruments for special nursing settings be developed in accordance with the item response theory (IRT)/Rasch model.

The selection of ethical sensitivity measurement instruments in nursing, and further research on the development, psychometric, and cross-cultural adaptation of these instruments, could be conducted in accordance with the findings and suggestions of this systematic review.

• This review was conducted to assess 11 instruments that were used to measure ethical sensitivity in nursing in 29 studies. • The Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units can be recommended, but further reliability and cross-cultural validity testing are needed. • The IRT/Rasch model is also recommended to measure ethical sensitivity in nursing. • The potential limitation of utilizing the COSMIN checklist for assessing methodological quality is worth considering. • Test-retest was considered inappropriate; thus, the reliability testing of ethical sensitivity measurement instruments still needs to be explored.

To determine the cumulative incidence and features of glaucoma in patients with Vogt-Koyanagi-Harada (VKH) syndrome compared with nonglaucoma patients.

Knowing the exact burden of secondary glaucoma in VKH could guide its screening and management in clinical practice as a part of the regular follow-up for patients with VKH.

The review protocol was preregistered on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO) [CRD42023462794]. PubMed, Scopus, Web of Science, EBSCOhost, and Google Scholar were searched for studies reporting the cumulative incidence and features of glaucoma presentation in VKH. A manual search was also conducted to supplement the primary search. Subgroup analyses based on glaucoma type, VKH stage, and patients' age were conducted. All analyses were conducted using STATA. Fixed- and random-effects models were selected according to the observed heterogeneity. Studies' methodological quality was determined using the National Institutes of Health tool.

The analysis of 7084 eyes revealed a progressive increase in the cumulative incidence of secondary glaucoma over time. The cumulative incidence was lowest at VKH onset (7%) and highest at 15 years (26%). Open-angle (12%; 95% confidence interval [CI]: 9%-14%) is more common than angle-closure glaucoma (7%; 95% CI: 3%-13%). Glaucoma cumulative incidence is highest in the chronic recurrent stage of VKH (33%; 95% CI: 12%-59%) and among children < 18 years of age (26%; 95% CI: 16%-37%). Features associated with glaucoma occurrence in VKH showed comparable rates with nonglaucoma cases. However, a meta-analysis to determine risk factors of glaucoma development in VKH was not feasible secondary to the lack of adjusted risk measures in included studies. Studies' quality was questionable in 5 studies. The certainty of evidence was moderate-to-high.

The cumulative incidence of glaucoma increases throughout VKH's course, with a higher tendency in children, chronic recurrent stages, and long-term follow-up. Future research should focus on examining risk factors of glaucoma development in VKH through adjusted multivariable regression models.

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Antibiotics residues even low concentrations increases human health risk and ecological risk. The current study was conducted with the aims of meta-analysis concentrations of antibiotics in river water including amoxicillin (AMX), tetracyclines (TCN), sulfamethoxazole (SMX), ciprofloxacin (CIP), trimethoprim (TMP), azithromycin (AZM) and amoxicillin (AMX) and estimates human health and ecological risks. Search was performed in databases including Scopus, PubMed, Web of Science, Embase, Science direct, Cochrane, Science Direct, Google Scholar were used to retrieve scientific papers from January 1, 2004 to June 15, 2024. The concentration of antibiotics residues was meta-analyzed using random effects model in water river water based on type of antibiotics subgroups. Human health risk assessment from ingestion and dermal contact routs was estimated using target hazard quotient (THQ), total target hazard quotient (TTHQ), carcinogenic (CR) and ecological hazard quotient (EHQ) of antibiotics in river water was estimated using monte carlo simulations (MCS) model. Sixty-two papers on antibiotics in river water with 272 data-reports (n = 28,522) were included. The rank order of antibiotics residues in river water based on pooled concentration was SMX (66.086 ng/L) > CIP (26.005 ng/L) > TCN (17.888 ng/L) > TMP (6.591 ng/L) > AZM (2.077 ng/L) > AMX (0.029 ng/L). The overall pooled concentration of antibiotics residues in river water was 24.262 ng/L, 95 %CI (23.110-25.413 ng/L). TTHQ for adults and children due to antibiotics in water was 2.41E-3 and 2.36E-3, respectively. The sort of antibiotics based on their quota in TTHQ for adults and children was AMX > CIP > TMP > AZM > TCN > SMX. Total CR in adults and children was 2.41E-03 and 2.36E-03, respectively. The sort of antibiotics based on percentile 95 % EHQ was SMX (7.70E+03) > TCN (7.63E+01) > TMP (7.03E-03) > CIP (2.86E-03) > AMX (5.71E-04) and TEHQ values due to antibiotics in river water in China was equal to 7.78E+03. Current study suggests that conduct effective monitoring and water quality control plans to reduce concentration of antibiotics especially SMX, TCN, and CIP in river water of China.

Primary bone tumors (PBT), although rare, could pose significant mortality and morbidity risks due to their high incidence of lung metastasis. Survival rates of patients with PBTs may vary based on the tumor type, therapeutic interventions, and the time of diagnosis. Despite advances in the management of patients with these tumors over the past four decades, the survival rates seem not to have improved significantly, implicating the need for novel therapeutic interventions. Surgical resection with wide margins, radiotherapy, and systemic chemotherapy are the main lines of treatment for PBTs. Neoadjuvant and adjuvant chemotherapy, along with emerging immunotherapeutic approaches such as chimeric antigen receptor (CAR)-T cell therapy, have the potential to improve the treatment outcomes for patients with PBTs. CAR-T cell therapy has been introduced as an option in hematologic malignancies, with FDA approval for several CD19-targeting CAR-T cell products. This review aims to highlight the potential of immunotherapeutic strategies, specifically CAR T cell therapy, in managing PBTs.

Procrastination is a personality tendency with several deleterious consequences. Trait mindfulness has been found to be associated with procrastination. Nevertheless, the relationship between trait mindfulness and procrastination has yielded inconsistent results in previous studies. Therefore, by utilizing a three-level random-effects meta-analysic model, the present study synthesized previous studies to investigate the relationship between trait mindfulness and procrastination and explore the potential moderators that may affect this relationship. A significant and negative relationship between trait mindfulness and procrastination (r = -0.365; p < 0.0001) was found by analyzing 36 effect sizes from 19 studies with 14,094 participants. The subsequent moderator analysis did not reveal any significant moderators. Overall, the current meta-analysis shed insightful light on information for future research on reducing procrastination by considering utilizing mindfulness-based interventions that make it easier for individuals to maintain a mindfulness state and enhance trait mindfulness, thereby reducing procrastination.

Four hundred and sixty-six references with 625 data reports were included in our study. The high frequency of ratio OC/EC for PM0.1 was observed in 3.92-5.93; PM1 in 1.08-3.08; PM2.5, 2.08-4.08; PM10 in 2.70-4.70 and TSP in 2.66-4.66. The rank order of areas based on the pooled concentration of OC bound to PM2.5 was traffic (17.893 µg/m3) > industrial (10.58 µg/m3) > urban (7.696 µg/m3) > rural (4.08 µg/m3). The rank order of areas based on the pooled (mean) concentration of EC in PM2.5 was traffic (17.893 µg/m3) > industrial (2.65 µg/m3) > Urban (1.48 µg/m3) > rural (1.06 µg/m3). The pooled concentrations of OC and EC bound to PM2.5 in traffic areas were higher than in other areas. Therefore, it is recommended that monitoring and effectively reducing concentration plans are carried out, especially in traffic areas.

Topical and systemic corticosteroids are the most effective medical treatment for nasal polyps, this study aims to systematically explore the efficacy and safety of mometasone furoate (MTF) for patients with nasal polyps (NP). The systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and was registered in The International Prospective Register of Systematic Reviews (PROSPERO.) Data were extracted from relevant and appropriate randomized controlled trials (RCTs) of synthetic corticosteroids for patients with nasal polyps from PubMed, Google Scholar, Web of Science, and Science Direct, encompassing studies published between January 1995 and July 2024. A total of 834 publications were found based on the search criteria. Around 1,710 patients were reviewed for this systematic review from full full-text articles. Primary outcomes include a change in polyp size (assessed by total polyp size scores), and nasal congestion (assessed by measuring changes from baseline in nasal congestion/obstruction scores). secondary outcomes consist of nasal symptoms, including loss of smell, anterior rhinorrhea, postnasal drip, quality of life outcomes, and adverse events. Mometasone furoate nasal spray (MFNS) significantly improves nasal symptoms and reduces nasal polyp size for patients with nasal polyps (NP).

Autoimmune skin diseases (ASDs) such as psoriasis and vitiligo, in addition to causing visible skin symptoms, are closely associated with psychological health issues. However, a comprehensive understanding of the prevalence of these psychological comorbidities in affected individuals is lacking. This study aims to identify the prevalence of anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation in people with ASDs.

PubMed, MEDLINE, Web of Science, and Cochrane Library searches were conducted from 1993 to May 2024. Observational studies reporting prevalence data for anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation among people with ASDs were included in the analysis. The Newcastle-Ottawa scale was used to evaluate the quality of studies.

The study included 114 studies from 37 countries including 823,975 participants. The estimated pooled prevalence of anxiety in patients with ASDs was 33.3% (95% CI: 27.3-29.3%). The estimated pooled prevalence of depression was 33.7% (95% CI: 29.2-38.1%). The estimated pooled prevalence of sleeping problems was 45.0% (95% CI:31.6-58.4%). The estimated pooled prevalence of cognitive impairment and suicidal ideation was 30.8% (95% CI:15.0-46.7%) and 21.6% (95% CI:13.4-29.8%), respectively. The most common mental disorder in patients with systemic lupus erythematosus and psoriasis was sleeping problems at 55.9% (95% CI: 35.6-76.1%, I2 = 97%) and 39.0% (95% CI: 21.1-56.9%, I2 = 99%).

Among patients with ASDs, anxiety, depression, sleeping problems, cognitive impairment, and suicidal ideation were common. The most prevalent mental disorder among patients with systemic lupus erythematosus and psoriasis was sleeping problems. Those with ASDs may experience considerable psychological burdens, and integrated mental health support is necessary for their treatment.

The term temporomandibular disorder (TMD) indicates a set of musculoskeletal conditions involving temporomandibular joint (TMJ), masticatory musculature, and related anatomical structures. Pain is the most common clinical manifestation of TMD, and the auditory system might be involved and affected, through tinnitus, dizziness, otalgia and ear fullness sensation.

The aim of this systematic review of randomised controlled trails (RCTs) was to evaluate the efficacy of rehabilitative approaches on otologic symptoms in patients with TMD.

PubMed, Scopus and Web of Science were systematically searched from the inception until 8th October 2023 to identify RCTs presenting participants with a diagnosis of TMD associated with otologic signs and symptoms, rehabilitative approaches as interventions, and modification of the otological symptoms as outcome.

Out of 931 papers suitable for title/abstract screening, 627 articles were assessed for eligibility. Five studies were included reporting the efficacy of occlusal splint therapy, low-level laser therapies, and physical therapy in patients diagnosed whit secondary otalgia or tinnitus associated with TMD. No RCTs evaluating other otologic symptoms, ear fullness, dizziness or vertigo were found.

Results of this systematic review suggested that rehabilitative approaches might be effective in improving secondary otalgia and tinnitus in TMD patients. Thus, further RCTs with a higher level of evidence and more representative samples should be conducted to better understand the effects of TMD therapy on otologic complains.

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.

This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).

Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).

We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.

Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.

This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.

Pulmonary thromboendarterectomy (PTE) is the current gold standard treatment for chronic thromboembolic pulmonary hypertension (CTEPH) and is a viable treatment option for chronic thromboembolic pulmonary disease (CTEPD). The progressive nature of both diseases severely impacts health-related quality of life (HRQoL) across a variety of domains. This systematic review was performed to evaluate the impact of PTE on short- and long-term HRQoL. A literature search was conducted on PubMed for studies matching the eligibility criteria between January 2000 and September 2022. OVID (MEDLINE), Google Scholar, EBSCOhost (EMBASE), and bibliographies of included studies were reviewed. Inclusion of studies was based on predetermined eligibility criteria. Quality appraisal and data tabulation were performed using predetermined forms. Results were synthesized by narrative review. The structure of this systematic review follows the PRISMA guidelines. This systematic review was prospectively registered in the PROSPERO register (CRD42022342144). Thirteen studies (2184 patients) were included. Within 3 months post-PTE, HRQoL improved in both CTEPD and CTEPH as measured by disease-specific and generic questionnaires. HRQoL improvements were sustained up to 5 years postoperatively in patients with CTEPH post-PTE. PTE remains the gold standard for treating CTEPH and improving HRQoL. Residual pulmonary hypertension and comorbidities such as COPD and coronary artery disease decrement HRQoL over time. The impact of mPAP and PVR on HRQoL outcomes postoperatively remain ambiguous. Pulmonary thromboendarterectomy remains the gold standard for treating CTEPH and has shown to improve HRQoL outcomes at 3-month sustaining improvements up to 5-year postoperatively. Residual pulmonary hypertension and comorbidities hinder HRQoL outcomes post-PTE.

Data regarding the worldwide gastrointestinal surgery rates in patients with Crohn's disease (CD) remains limited.

To systematically review the global variation in the rates of surgery in CD.

A comprehensive search analysis was performed using multiple electronic databases from inception through July 1, 2020, to identify all full text, randomized controlled trials and cohort studies pertaining to gastrointestinal surgery rates in adult patients with CD. Outcomes included continent based demographic data, CD surgery rates over time, as well as the geoepidemiologic variation in CD surgery rates. Statistical analyses were conducted using R.

Twenty-three studies spanning four continents were included. The median proportion of persons with CD who underwent gastrointestinal surgery in studies from North America, Europe, Asia, and Oceania were 30% (range: 1.7%-62.0%), 40% (range: 0.6%-74.0%), 17% (range: 16.0%-43.0%), and 38% respectively. No clear association was found regarding the proportion of patients undergoing gastrointestinal surgery over time in North America (R 2 = 0.035) and Europe (R 2 = 0.100). A moderate, negative association was seen regarding the proportion of patients undergoing gastrointestinal surgery over time (R 2 = 0.520) in Asia.

There appears to be significant inter-continental variation regarding surgery rates in CD. Homogenous evidence-based guidelines accounting for the geographic differences in managing patients with CD is prudent. Moreover, as a paucity of data on surgery rates in CD exists outside the North American and European continents, future studies, particularly in less studied locales, are warranted.

Introduction: Telehealth in India is growing rapidly and represents a strategy to promote affordable, inclusive, timely and safe access to healthcare. Yet there is a risk that telehealth increases inequity due to the digital divide and existing poor health literacy. Methods: A scoping review was conducted to explore use of telehealth in India during and following the COVID-19 pandemic by people with disabilities to inform strategies to increase equity of telehealth for people with disabilities. Of 1966 studies from the initial search in four databases and three specific telehealth journals, 20 sources met the inclusion criteria, limited to a focus on physical disability in India. Results: Findings showed examples of how people with disabilities can exercise increased control in the timing of appointments, convenience of receiving services from home and not having to travel to clinics or hospitals, and platform preference through tools and applications already familiar to them. Carers and families of people with disabilities were described as highly valued stakeholders with important roles in the uptake and effectiveness of telehealth for people with disabilities. The identified benefits of telehealth resulted in high levels of user satisfaction due to increased control and convenience, however, systemic barriers for accessibility remain. Conclusion: This review suggested that if telehealth is not designed intentionally to change the status quo for people with disabilities and prioritize equity, then the benefits may not be sustainable. Recommendations for telehealth India are provided, based on both findings from the literature and analysis of results.

The objective was to investigate the current evidence and discern urinary continence rates post robot-assisted laparoscopic radical prostatectomy (RALP).

A systematic review of the literature was carried out, searching the Embase, Scopus and PubMed databases between 1 January 2000 and 1 May 2020. The search terms "Robotic prostatectomy AND continence" were employed. Articles were selected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Statistical analysis was performed using the programme R; cumulative analysis of percentage of men continent was calculated.

A total of 3101 abstracts and 50 full text articles were assessed, with 22 publications included (n = 2813 patients). There were 21 randomised controlled trials and one partly randomised controlled trial with four publications comparing RALP to other prostate cancer treatments. Thirteen studies explored different RALP techniques, and five studies examined vesicourethral anastomosis (VUA). There were statistically significant improvements in early urinary continence rates in three studies analysing reconstructive techniques (83% vs 60%, p = 0.04; 26.5% vs 15.4%, p = 0.016; 77% vs 44.1%, p ≤ 0.001). Long-term continence rates were not significantly improved across all studies assessing reconstruction. One study comparing RALP vs laparoscopic radical prostatectomy (LRP) demonstrated a statistically significant improvement in continence at 3 months (80% vs 73.3%, p < 0.001); 6 months (83.3% vs 81.4%, p < 0.001); 12 months (95% vs 83.3%, p < 0.001) and 24 months (96.7% vs 85%, p < 0.001). Early continence was less favourable for RALP when compared to brachytherapy (BT) patients at 3 months (86% vs 98.7%, p < 0.05) and 6 months (90.5% vs 98.7%, p < 0.05).

Early continence rates were improved across numerous techniques in RALP. These results were not translated into significantly improved long-term outcomes. Continence rates following RALP were favourable compared to LRP, similar to ORP and less favourable compared to BT. Our findings suggest that post-RALP continence can be further improved with alterations in robotic technique.

This systematic review aimed to evaluate the effectiveness of conservative approaches on otologic signs and symptoms in patients affected by Menière's Disease (MD) and temporomandibular disorders (TMD).

PubMed, Scopus, and Web of Science were systematically searched to identify studies presenting participants with a diagnosis of MD associated with TMD, conservative approaches as interventions, and modification of the otological signs and symptoms as outcome.

Out of 627 articles assessed for eligibility, two studies were included. Both studies showed a significant reduction of Situational Vertigo Questionnaire after treatment, number of vertigo spells, Functional Level Scale, Dizziness Hearing Inventory, and Tinnitus Handicap Inventory, after occlusal splint therapy. No significant differences were found in terms of pure-tone audiometry average.

Findings of this systematic review suggested that conservative approaches might improve vertigo in patients affected by MD and TMD. However, the low number of included studies makes difficult to draw strong conclusions.