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Ageing Research Reviews Dec 2023Alterations in nitric oxide (NO) synthesis have been reported in Alzheimer's disease and vascular dementia. However, as the measurement of NO in biological samples is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alterations in nitric oxide (NO) synthesis have been reported in Alzheimer's disease and vascular dementia. However, as the measurement of NO in biological samples is analytically challenging, alternative, stable circulatory biomarkers of NO synthesis may be useful to unravel new pathophysiological mechanisms and treatment targets in dementia.
METHODS
We conducted a systematic review and meta-analysis of the circulating concentrations of arginine metabolites linked to NO synthesis, arginine, citrulline, asymmetric (ADMA) and symmetric (SDMA) dimethylarginine, and ornithine, in Alzheimer's disease and vascular dementia. We searched for relevant studies in PubMed, Scopus, and Web of Science from inception to the 31st of May 2023. The JBI checklist and GRADE were used to assess the risk of bias and the certainty of evidence, respectively.
RESULTS
In 14 selected studies, there were no significant between-group differences in arginine and ornithine concentrations. By contrast, compared to controls, patients with dementia had significantly higher ADMA (standard mean difference, SMD=0.62, 95% CI 0.06-1.19, p = 0.029), SDMA (SMD=0.70, 95% CI 0.34-1.35, p<0.001), and citrulline concentrations (SMD=0.50, 95% CI 0.08-0.91, p = 0.018). In subgroup analysis, the effect size was significantly associated with treatment with cholinesterase inhibitors and/or antipsychotics for ADMA, and underlying disorder (Alzheimer's disease), study continent, and analytical method for citrulline.
CONCLUSION
Alterations in ADMA, SDMA, and citrulline, biomarkers of NO synthesis, may be useful to investigate the pathophysiology of different forms of dementia and identify novel therapeutic strategies. (PROSPERO registration number: CRD42023439528).
Topics: Humans; Alzheimer Disease; Dementia, Vascular; Citrulline; Arginine; Biomarkers; Ornithine
PubMed: 38007048
DOI: 10.1016/j.arr.2023.102139 -
British Journal of Anaesthesia Jun 2023Chronic pain and depression represent two global health problems with considerable economic consequences. Although existing literature reports on the relation between... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic pain and depression represent two global health problems with considerable economic consequences. Although existing literature reports on the relation between depression and pain conditions, meta-analytic evidence backing the mediating role of sleep disturbance as one of the main symptoms of depression is scarce. To examine the extent to which sleep disturbance mediates the depression-chronic pain association, we conducted a systematic review and meta-analysis of the associations of chronic pain, depression, and sleep quality.
METHODS
We systematically searched for literature in MEDLINE and other relevant databases and identified cohort and case-control studies on depression, sleep disturbance, and chronic pain. Forty-nine studies were eligible, with a total population of 120 489 individuals. We obtained direct and indirect path coefficients via two-stage meta-analytic structural equation modelling, examined heterogeneity via subgroup analyses, and evaluated primary studies quality.
RESULTS
We found a significant, partial mediation effect of sleep disturbance on the relation between depression and chronic pain. The pooled path coefficient (coef.) of the indirect effect was 0.03 (95% confidence interval [CI]: 0.01-0.05) and accounted for 12.5% of the total effect of depression on chronic pain. This indirect effect also existed for cohort studies (coef. 0.02; 95% CI: 0.002-0.04), European studies (coef. 0.03; 95% CI: 0.004-0.05), and studies that adjusted for confounders (coef. 0.04; 95% CI: 0.01-0.09).
CONCLUSIONS
Sleep disturbance partially mediates the association between depression and pain. Although plausible mechanisms could explain this mediation effect, other explanations, including reverse causation, must be further explored.
SYSTEMATIC REVIEW PROTOCOL
PROSPERO CRD42022338201.
Topics: Humans; Chronic Pain; Depression; Sleep Quality; Sleep; Sleep Wake Disorders
PubMed: 37059623
DOI: 10.1016/j.bja.2023.02.036 -
The British Journal of Educational... Sep 2022There is a plethora of reviews that summarize much of the evidence base in Social and Emotional Learning (SEL). However, there are criticisms around variability of... (Review)
Review
BACKGROUND
There is a plethora of reviews that summarize much of the evidence base in Social and Emotional Learning (SEL). However, there are criticisms around variability of quality and focus of those reviews, meaning there is little strategic overview of the current state of the field. Further, there are rising concerns as to systemic gaps in the evidence base itself. An overview of reviews provides an opportunity for a comprehensive classification and corresponding critique of evidence.
AIMS
The study sought to examine a-priori concerns regarding (1) variation in the rigour and quality of the meta-analytic and systematic evidence base, (2) comparatively less conclusive evidence for whole school approaches when compared to class-based curricula, and (3) an assumed universality of effect (i.e., lack of examination of any differential gains for sub-groups).
METHOD AND RESULTS
A systematic search of the systematic and meta-analytic literature identified a total of 33 reviews examining SEL interventions. Papers were subject to a quality assessment in order to examine methodological rigour and were collated in line with the study's objectives.
CONCLUSIONS
We maintain the prevailing consensus that SEL programmes have an important role in education. However, variation in evidence quality remains high and there appear ambiguities regarding what constitutes whole school approaches. The review also highlights a novel and concerning lack of data for differentiating any subgroup effects. The review concludes with recommended novel directions for future research, including adoption of more complex trial architecture in evaluation alongside a move towards a wider plurality in methodological approach.
Topics: Cognition; Emotions; Humans; Schools
PubMed: 34921555
DOI: 10.1111/bjep.12480 -
Contraception Nov 2023This study aimed to update our 2019 systematic review of data on the effectiveness and safety of misoprostol-only for first-trimester abortion. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study aimed to update our 2019 systematic review of data on the effectiveness and safety of misoprostol-only for first-trimester abortion.
STUDY DESIGN
We searched PubMed on December 18, 2022, to find published articles describing the outcomes of treatment with misoprostol-only for abortion of viable intrauterine pregnancy at ≤91 days of gestation. From each article identified, two authors independently abstracted relevant data about each group of patients treated with a distinct regimen. We assessed the risk of bias using four defined indicators. We estimated the proportion of patients with treatment failure using meta-analytic methods as well as the proportion hospitalized or transfused after treatment. We examined associations between treatment failure and selected characteristics of the groups.
RESULTS
We identified 49 papers with 66 groups that collectively included 16,354 evaluable patients, of whom 2960 (meta-analytic estimate 15%, 95% CI 12%, 19%) had treatment failures. Of 9228 patients assessed for ongoing pregnancy after treatment, 521 (meta-analytic estimate 6%, 95% CI 5%, 8%) had that condition. Failure risk was significantly associated with misoprostol dose, the total allowed number of doses, the maximum duration of dosing, and certain indicators of risk of bias. Among 11,007 patients allowed to take at least three misoprostol doses, the first consisting of misoprostol 800 mcg administered vaginally, sublingually, or buccally, the meta-analytic estimate of the failure risk was 11% (95% CI 8%, 14%). At most, 0.2% of 15,679 evaluable patients were hospitalized or received transfusions.
CONCLUSIONS
Although some studies in this updated review were adjudicated to have a high risk of bias, the results continue to support the key conclusion of our 2019 analysis: misoprostol-only is effective and safe for the termination of first-trimester intrauterine pregnancy.
IMPLICATIONS
Misoprostol-only is a safe and effective option for medication abortion in the first trimester if mifepristone is unavailable or inaccessible.
Topics: Pregnancy; Female; Humans; Misoprostol; Abortifacient Agents; Pregnancy Trimester, First; Mifepristone; Abortion, Induced; Abortifacient Agents, Nonsteroidal
PubMed: 37517447
DOI: 10.1016/j.contraception.2023.110132 -
Sports Medicine (Auckland, N.Z.) Aug 2022Carbohydrates are an important fuel for optimal exercise performance during moderate- and high-intensity exercise; however, carbohydrate ingestion during high-intensity... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Carbohydrates are an important fuel for optimal exercise performance during moderate- and high-intensity exercise; however, carbohydrate ingestion during high-intensity exercise may cause gastrointestinal upset. A carbohydrate oral rinse is an alternative method to improve exercise performance in moderate- to high-intensity exercise with a duration of 30-75 min. This is the first systematic review and meta-analysis to comprehensively examine the isolated effect of maltodextrin-based rinsing on exercise performance.
OBJECTIVE
The objective of this review was to establish the effect of a maltodextrin-based carbohydrate oral rinse on exercise performance across various modes of exercise. Furthermore, a secondary objective was to determine the effects of moderators [(1) participant characteristics; (2) oral rinse protocols; (3) exercise protocol (i.e. cycling, running etc.) and (4) fasting] on exercise performance while using a maltodextrin-based, carbohydrate oral rinse.
METHODS
Five databases (MEDLINE, PsycINFO, Embase, SPORTDiscus and Global Health) were systematically searched for articles up to March 2021 and screened using Covidence (a systematic review management tool). A random effects robust meta-analysis and subgroup analyses were performed using Stata Statistical Software: Release 16.
RESULTS
Thirty-five articles met the inclusion criteria and were included in the systematic review; 34 of these articles were included in the meta-analysis. When using a conventional meta-analytic approach, overall, a carbohydrate oral rinse improved exercise performance in comparison with a placebo (SMD = 0.15, 95% CI 0.04, 0.27; p = 0.01). Furthermore, when implementing an adjusted, conservative, random effects meta-regression model using robust variance estimation, overall, compared with placebo, a carbohydrate oral rinse demonstrated evidence of improving exercise performance with a small effect size (SMD = 0.17, 95% CI - 0.01, 0.34; p = 0.051).
CONCLUSION
This systematic review and meta-analysis demonstrates that a maltodextrin-based carbohydrate oral rinse can improve exercise performance. When comparing the two meta-analytic approaches, although non-significant, the more robust, adjusted, random effects meta-regression model demonstrated some evidence of a maltodextrin-based carbohydrate oral rinse improving exercise performance overall.
Topics: Bicycling; Exercise; Humans; Mouthwashes; Polysaccharides
PubMed: 35239154
DOI: 10.1007/s40279-022-01658-3 -
Health Psychology : Official Journal of... Jan 2022Significant proportions of burnout have been reported among both oncologists and oncology nurses. However, these groups have not been compared in a meta-analytic design.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Significant proportions of burnout have been reported among both oncologists and oncology nurses. However, these groups have not been compared in a meta-analytic design. It is important to compare how burnout affects different types of health professionals to understand its individual implications and devise ways of minimizing and treating it.
OBJECTIVE
The current meta-analysis study aimed to systematically compare burnout prevalence between oncologists and oncology nurses.
METHOD
Authors assessed 34 studies (four included nurses and oncologists and 30 focused either on oncologists or oncology nurses) that used the Maslach Burnout Inventory (MBI) to measure burnout. Both fixed- and random-effects models were used to calculate meta-analytic estimates of the burnout subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA).
RESULTS
The pooled sample size was 4,705 oncologists and 6,940 oncology nurses. The average proportions of EE, DP, and PA were 32%, 26%, and 25%, respectively, among oncologists and 32%, 21%, and 26%, respectively, among oncology nurses. Higher DP was found among oncologists compared with oncology nurses, only in the analysis of studies that included samples of both oncologists and oncology nurses. The subgroup analysis showed higher levels of DP in Europe and Asia and lower PA in Asia and Canada. No evidence of publication bias was found.
CONCLUSIONS
Findings suggest differences in burnout between oncologists and oncology nurses and among geographic regions. This highlights the need for tailored interventions for different professions and regions. Hospitals should provide support and encourage teamwork to improve oncology professionals' well-being and provide optimal care for patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Burnout, Professional; Burnout, Psychological; Emotions; Humans; Oncologists; Prevalence; Surveys and Questionnaires
PubMed: 35113585
DOI: 10.1037/hea0001155 -
International Journal of Molecular... Mar 2023The concentration of biomolecules in living systems shows numerous systematic and random variations. Systematic variations can be classified based on the frequency of... (Review)
Review
The concentration of biomolecules in living systems shows numerous systematic and random variations. Systematic variations can be classified based on the frequency of variations as ultradian (<24 h), circadian (approximately 24 h), and infradian (>24 h), which are partly predictable. Random biological variations are known as between-subject biological variations that are the variations among the set points of an analyte from different individuals and within-subject biological variation, which is the variation of the analyte around individuals' set points. The random biological variation cannot be predicted but can be estimated using appropriate measurement and statistical procedures. Physiological rhythms and random biological variation of the analytes could be considered the essential elements of predictive, preventive, and particularly personalized laboratory medicine. This systematic review aims to summarize research that have been done about the types of physiological rhythms, biological variations, and their effects on laboratory tests. We have searched the PubMed and Web of Science databases for biological variation and physiological rhythm articles in English without time restrictions with the terms "Biological variation, Within-subject biological variation, Between-subject biological variation, Physiological rhythms, Ultradian rhythms, Circadian rhythm, Infradian rhythms". It was concluded that, for effective management of predicting, preventing, and personalizing medicine, which is based on the safe and valid interpretation of patients' laboratory test results, both physiological rhythms and biological variation of the measurands should be considered simultaneously.
Topics: Humans; Circadian Rhythm; Ultradian Rhythm
PubMed: 37047252
DOI: 10.3390/ijms24076275 -
Anesthesia and Analgesia Feb 2023Several frailty screening tools have been shown to predict mortality and complications after surgery. However, these tools were developed for in-person evaluation and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several frailty screening tools have been shown to predict mortality and complications after surgery. However, these tools were developed for in-person evaluation and cannot be used during virtual assessments before surgery. The FRAIL (fatigue, resistance, ambulation, illness, and loss of weight) scale is a brief assessment that can potentially be conducted virtually or self-administered, but its association with postoperative outcomes in older surgical patients is unknown. The objective of this systematic review and meta-analysis (SRMA) was to determine whether the FRAIL scale is associated with mortality and postoperative outcomes in older surgical patients.
METHODS
Systematic searches were conducted of multiple literature databases from January 1, 2008, to December 17, 2022, to identify English language studies using the FRAIL scale in surgical patients and reporting mortality and postoperative outcomes, including postoperative complications, postoperative delirium, length of stay, and functional recovery. These databases included Medline, Medline ePubs/In-process citations, Embase, APA (American Psychological Association) PsycInfo, Ovid Emcare Nursing, (all via the Ovid platform), Cumulative Index to Nursing and Allied Health Literature (CINAHL) EbscoHost, the Web of Science (Clarivate Analytics), and Scopus (Elsevier). The risk of bias was assessed using the quality in prognosis studies tool.
RESULTS
A total of 18 studies with 4479 patients were included. Eleven studies reported mortality at varying time points. Eight studies were included in the meta-analysis of mortality. The pooled odds ratio (OR) of 30-day, 6-month, and 1-year mortality for frail patients was 6.62 (95% confidence interval [CI], 2.80-15.61; P < .01), 2.97 (95% CI, 1.54-5.72; P < .01), and 1.54 (95% CI, 0.91-2.58; P = .11), respectively. Frailty was associated with postoperative complications and postoperative delirium, with an OR of 3.11 (95% CI, 2.06-4.68; P < .01) and 2.65 (95% CI, 1.85-3.80; P < .01), respectively. The risk of bias was low in 16 of 18 studies.
CONCLUSIONS
As measured by the FRAIL scale, frailty was associated with 30-day mortality, 6-month mortality, postoperative complications, and postoperative delirium.
Topics: Humans; Aged; Frailty; Frail Elderly; Emergence Delirium; Geriatric Assessment; Postoperative Complications
PubMed: 36638509
DOI: 10.1213/ANE.0000000000006272 -
Quantitative Imaging in Medicine and... Mar 2023Accident and Emergency Department (AED) is the frontline of providing emergency care in a hospital and research focusing on improving decision-makings and service level... (Review)
Review
BACKGROUND
Accident and Emergency Department (AED) is the frontline of providing emergency care in a hospital and research focusing on improving decision-makings and service level around AED has been driving a rising number of attentions in recent years. A retrospective review among the published papers shows that related research can be classified according to six planning modules: demand forecasting, days-off scheduling, shift scheduling, line-of-work construction, task assignment and staff assignment. As patient arrivals demand forecasts enable smooth AED operational planning and help decision-making, this article conducted a systematic review on the statistical modelling approaches aimed at predicting the volume of AED patients' arrival.
METHODS
We carried out a systematic review of AED patient arrivals prediction studies from 2004 to 2021. The Medline, ScienceDirect, and Scopus databases were searched. A two-step screening process was carried out based on the title and abstract or full text, and 35 of 1,677 articles were selected. Our methods and results follow the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We categorise AED methods for modelling patient arrivals into four main classes: regression, time series, artificial intelligence and time series regression. Choice of prediction model, selection of factors and model performance are compared. Finally, we discuss the advantages and limitations of the models and suggest future research directions.
RESULTS
A total of 1,677 papers that fulfilled the initial searching criteria was obtained from the three databases. Based on the first exclusion criteria, 1,603 articles were eliminated. The remaining 74 full text articles were evaluated based on the second exclusion criteria. Finally, 35 articles were selected for full review. We find that the use of artificial intelligence-based model has risen in recent years, from the view of predictive model selection. The calendar-based factors are most commonly used compared with other types of dependent variables, from the view of dependent variable selection.
CONCLUSIONS
All AEDs are inherently different and different covariables may have different effects on patient arrivals. Certain factors may play a key role in one AED but not others. Based on results of meta-analysis, when modelling patient arrivals, it is essential to understand the actual AED situation and carefully select relevant dominating factors and the most suitable modelling method. Local calibration is also important to ensure good estimates.
PubMed: 36915315
DOI: 10.21037/qims-22-268 -
International Journal of Rheumatic... Jul 2023Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease, thought to be influenced by both genetics and the environment. Identifying... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease, thought to be influenced by both genetics and the environment. Identifying environmental factors associated with disease risk will improve knowledge of disease mechanisms and ultimately benefit patients. This review aimed to collate and synthesize the current evidence of environmental factors associated with JIA.
METHODS
MEDLINE (Ovid), EMBASE (Ovid), Cumulative Index of Nursing and Related Health Literature (EBSCOhost), science network (WOS, Clarivate Analytics), Chinese National Knowledge Infrastructure, and Chinese Biological Medical Database were systematically searched. Study quality was rated using the Newcastle-Ottawa Scale. Pooled estimates for each environmental factor were generated using a random-effects, inverse-variance method, where possible. The remaining environmental factors were synthesized in narrative form.
RESULTS
This review includes environmental factors from 23 studies (6 cohorts and 17 case-control studies). Cesarean section delivery was associated with increased JIA risk (pooled relative risk [RR] 1.103, 95% CI 1.033-1.177). Conversely, maternal smoking of more than 20 cigarettes/day (pooled RR 0.650, 95% CI 0.431-0.981) and gestational smoking (pooled RR0.634, 95% CI 0.452-0.890) were associated with decreased JIA risk.
CONCLUSION
This review identifies several environmental factors associated with JIA and demonstrates the huge breadth of environmental research. We also highlight the challenges of combining data collected over this period due to limited study comparability, evolution in healthcare and social practices, and changing environment, which warrant consideration when planning future studies.
Topics: Humans; Child; Pregnancy; Female; Arthritis, Juvenile; Cesarean Section; Smoking; Quality of Life; Case-Control Studies
PubMed: 37309290
DOI: 10.1111/1756-185X.14729