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BMC Cancer Jun 2024Despite the existence of numerous studies investigating the diagnostic potential of blood microRNAs for colorectal cancer, the microRNAs under consideration vary widely,... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
Despite the existence of numerous studies investigating the diagnostic potential of blood microRNAs for colorectal cancer, the microRNAs under consideration vary widely, and comparative analysis of their diagnostic value is lacking. Consequently, this systematic review aims to identify the most effective microRNA blood tumor markers to enhance clinical decision-making in colorectal cancer screening.
METHOD
A comprehensive search of databases, including PubMed, Embase, Web of Science, Scopus, and Cochrane, was conducted to identify case‒control or cohort studies that examined the diagnostic value of peripheral blood microRNAs in colorectal cancer. Studies were included if they provided sensitivity and specificity data, were published in English and were available between January 1, 2000, and February 10, 2023. The Critical Appraisal Skills Programme (CASP) checklist was employed for quality assessment. A Bayesian network meta-analysis was performed to estimate combined risk ratios (RRs) and 95% confidence intervals (CIs), with results presented via rankograms. This study is registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), 202,380,092.
RESULTS
From an initial pool of 2254 records, 79 met the inclusion criteria, encompassing a total of 90 microRNAs. The seven most frequently studied microRNAs (43 records) were selected for inclusion, all of which demonstrated moderate to high quality. miR-23, miR-92, and miR-21 exhibited the highest sensitivity and accuracy, outperforming traditional tumor markers CA19-9 and CEA in terms of RR values and 95% CI for both sensitivity and accuracy. With the exception of miR-17, no significant difference was observed between each microRNA and CA19-9 and CEA in terms of specificity.
CONCLUSIONS
Among the most extensively researched blood microRNAs, miR-23, miR-92, and miR-21 demonstrated superior diagnostic value for colorectal cancer due to their exceptional sensitivity and accuracy. This systematic review and network meta-analysis may serve as a valuable reference for the clinical selection of microRNAs as tumor biomarkers.
Topics: Humans; Colorectal Neoplasms; Biomarkers, Tumor; MicroRNAs; Network Meta-Analysis; Sensitivity and Specificity; Early Detection of Cancer; Bayes Theorem
PubMed: 38926893
DOI: 10.1186/s12885-024-12528-8 -
Journal of Clinical Epidemiology Jun 2024Prognostic models have the potential to aid clinical decision-making after hip fracture. This systematic review aimed to identify, critically appraise and summarise...
Systematic review of multivariable prognostic models for outcomes at least 30 days after hip fracture finds 18 mortality models but no non-mortality models warranting validation.
OBJECTIVE
Prognostic models have the potential to aid clinical decision-making after hip fracture. This systematic review aimed to identify, critically appraise and summarise multivariable prediction models for mortality or other long-term recovery outcomes occurring at least 30 days after hip fracture.
STUDY DESIGN
MEDLINE, Embase, Scopus, Web of Science and CINAHL databases were searched up to May 2023. Studies were included that aimed to develop multivariable models to make predictions for individuals at least 30 days after hip fracture. Risk of bias (ROB) was dual-assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Study and model details were extracted and summarised.
RESULTS
From 5,571 records, 80 eligible studies were identified. They predicted mortality in n=55 studies/ 81 models, and non-mortality outcomes (mobility, function, residence, medical and surgical complications) in n=30 studies/ 45 models. Most (n=46; 58%) studies were published since 2020. A quarter of studies (n=19; 24%) reported using 'machine-learning methods', while the remainder used logistic regression (n=54; 68%) and other statistical methods (n=11; 14%) to build models. Overall, 15 studies (19%) presented 18 low ROB models, all predicting mortality. Common concerns were sample size, missing data handling, inadequate internal validation and calibration assessment. Many studies with non-mortality outcomes, (n=11; 37%) had clear data complexities that were not correctly modelled.
CONCLUSION
This review has comprehensively summarised and appraised multivariable prediction models for long-term outcomes after hip fracture. Only 15 studies out of 55 predicting mortality were rated as low ROB, warranting further development of their models. All studies predicting non-mortality outcomes were high or unclear ROB. Careful consideration is required for both the methods used and justification for developing further non-mortality prediction models for this clinical population.
PubMed: 38925343
DOI: 10.1016/j.jclinepi.2024.111439 -
World Neurosurgery Jun 2024When it comes to intracranial aneurysms, the quest for more effective treatments is ongoing. Flow diversion represents a growing advancement in this field. This review... (Review)
Review
BACKGROUND
When it comes to intracranial aneurysms, the quest for more effective treatments is ongoing. Flow diversion represents a growing advancement in this field. This review seeks to compare two variants of the endovascular flow diversion method: the Flow Re-Direction Endoluminal Device (FRED) and the Pipeline Embolization Device (PED).
METHODS
A systematic review was conducted according to the PRISMA guideline using PubMed, Scopus, Web of Science, and Embase, using appropriate terms to compare PED and FRED in double-arm studies from conception until October 8, 2023.
RESULTS
The meta-analysis encompassed 1,769 patients, with a predominance of females (75.5%), among whom 973 patients underwent FRED procedures, while 651 received PED interventions. At six months, complete occlusion rates were 0.62 for FRED and 0.68 for PED (P = 0.68). At one year and the last follow-up, no significant differences were observed between FRED and PED, respectively. Adequate occlusion rates were similar between FRED and PED (0.82 vs 0.79, P = 0.68). FRED showed a statistically significant higher rate of good mRS scores at follow-up (1.00 vs. 0.97, P = 0.03). Hemorrhage and re-treatment rates were higher in PED (P < 0.01) without considering the rupture status of the aneurysms due to the lack of data.
CONCLUSION
This meta-analysis suggests comparable efficacy but different safety profiles between FRED and PED in treating intracranial aneurysms. FRED demonstrated a higher rate of good mRS scores, while PED showed increased hemorrhage and re-treatment rates. Understanding these differences is crucial for informed decision-making in clinical practice.
PubMed: 38925243
DOI: 10.1016/j.wneu.2024.06.100 -
Nurse Education Today Jun 2024Simulation-based education methods improve nursing students' clinical decision-making skills. It allows students to experience situations they may not encounter in a... (Review)
Review
BACKGROUND
Simulation-based education methods improve nursing students' clinical decision-making skills. It allows students to experience situations they may not encounter in a real clinical environment.
OBJECTIVES
The aim of this systematic review was to better understand the effectiveness of simulation-based education on clinical decision-making skills in undergraduate nursing students.
DESIGN
Meta-analysis of randomized controlled trials and quasi-experimental studies.
DATA SOURCES
The review included fourteen studies obtained by scanning the PubMed, EBSCO (Medline, CINAHL), OVID, Web of Science, and Cochrane databases.
REVIEW METHODS
Three authors independently screened the literature, extracted data, and assessed the quality of the included studies. The methodological quality of the studies was assessed with the Critical Appraisal Checklists for experimental and quasi-experimental studies developed by the Joanna Briggs Institute. Standardized mean difference with 95 % confidence interval was used to facilitate direct comparisons between studies. All statistical tests were performed with Review Manager 5.4 software.
RESULTS
In this study, 1614 records were reached as a result of the first screening. After examining the titles and removing duplicate articles and other articles that did not meet the research criteria according to the abstracts, 48 articles were included in the full-text analysis. Three researchers read the studies (n = 48) eligible for evaluation, and 14 (n = 14) studies suitable for full-text review met all of the listed inclusion criteria and were included in the meta-analysis.
CONCLUSION
The analysis revealed that simulation-based educational practices appeared to improve undergraduate nursing students' clinical decision-making skills.
PubMed: 38924975
DOI: 10.1016/j.nedt.2024.106270 -
Expert Review of Vaccines 2024The global measles incidence has decreased from 145 to 49 cases per 1 million population from 2000 to 2018, but evaluating the economic benefits of a second...
INTRODUCTION
The global measles incidence has decreased from 145 to 49 cases per 1 million population from 2000 to 2018, but evaluating the economic benefits of a second measles-containing vaccine (MCV2) is crucial. This study reviewed the evidence and quality of economic evaluation studies to guide MCV2 introduction.
METHODS
The systematic review of model-based economic evaluation studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search yielded 2231 articles, with 876 duplicates removed and 1355 articles screened, with nine studies included for final analysis.
RESULTS
Six studies reported a positive benefit-cost ratio with one resulting in net savings of $11.6 billion, and two studies estimated a 2-dose MMR vaccination program would save $119.24 to prevent one measles case, and a second dose could prevent 9,200 cases at 18 months, saving $548.19 per case. The most sensitive variables were the discount rate and vaccination administration cost.
CONCLUSIONS
Two MCV doses or a second opportunity with an additional dose of MCV were highly cost-beneficial and resulted in substantial cost savings compared to a single routine vaccine. But further research using high-quality model-based health economic evaluation studies of MCV2 should be made available to decision-makers.
PROSPERO REGISTRATION
CRD42020200669.
Topics: Humans; Cost-Benefit Analysis; Immunization Programs; Immunization, Secondary; Measles; Measles Vaccine; Measles-Mumps-Rubella Vaccine; Vaccination
PubMed: 38924461
DOI: 10.1080/14760584.2024.2367451 -
Minerva Anestesiologica Jun 2024Decision-making about organ donation (OD) is influenced by interrelated cognitive and non-cognitive factors. The identification of these factors in the general...
INTRODUCTION
Decision-making about organ donation (OD) is influenced by interrelated cognitive and non-cognitive factors. The identification of these factors in the general population and among healthcare professionals (HCP) in Italy are key ethical and scientific requirements to inform targeted communication and policy-making interventions, and to promote decision-making processes that are truly informed.
EVIDENCE ACQUISITION
A systematic review of articles published between January 1, 1999, and January 31, 2024 was performed by searching four databases using these terms: "organ donation" AND (attitude OR opinion OR knowledge OR awareness OR intention OR beliefs OR norms OR perception) AND (Italy OR Italian). The reference sections of included articles were scrutinized for additional references.
EVIDENCE SYNTHESIS
Most respondents (lay citizens and HCPs) were in favor of OD, but many (mainly but not exclusively lay citizens) would not authorize OD in the event of death of a family member. Lack of knowledge about OD and the gap between demand and supply of organs, fear of body mutilation, doubts about the criteria for brain death diagnosis, doubts about the wishes of the deceased family member, and distrust towards medical doctors and the healthcare system were the most commonly reported reasons, confirming that cognitive and non-cognitive factors are at play.
CONCLUSIONS
The majority of the Italian population supports OD, but cognitive and non-cognitive barriers are present even among HCPs. Communication campaigns, encouraging family discussions about OD, providing better education for HCPs (including medical and nursing students), and making it easier to sign OD cards may promote informed decision-making and possibly increase consent rates.
PubMed: 38922284
DOI: 10.23736/S0375-9393.24.18098-4 -
Cadernos de Saude Publica 2024Vaccines are often undervalued or underused for a variety of reasons, and vaccine hesitancy is a global challenge that threatens vaccine acceptance and the goals of... (Review)
Review
Vaccines are often undervalued or underused for a variety of reasons, and vaccine hesitancy is a global challenge that threatens vaccine acceptance and the goals of immunization programs. This review aimed to describe the barriers and facilitators to vaccination in Latin America. The study design was a systematic review and thematic synthesis of qualitative studies reporting on the knowledge or attitudes of adults, parents of children at vaccination age, adolescents and health professionals towards vaccination in Latin America. The databases searched were PubMed, CENTRAL, Scopus, LILACS, SciELO, and CINAHL. A total of 56 studies were included. Facilitators included vaccination being recognized as an effective strategy for preventing infectious diseases and as a requirement for access to social assistance programs, schooling or employment. Recommendations from health professionals and positive experiences with health services were also identified as facilitators. The main barriers were lack of information or counseling, structural problems such as shortages of vaccines and limited hours of operation, the inability to afford over-the-counter vaccines or transportation to health facilities, certain religious beliefs, misconceptions and safety concerns. Qualitative research can contribute to understanding perceptions and decision-making about vaccination and to designing policies and interventions to increase coverage.
Topics: Humans; Latin America; Qualitative Research; Health Knowledge, Attitudes, Practice; Vaccination; Vaccination Hesitancy; Health Services Accessibility; Immunization Programs; Patient Acceptance of Health Care; Adolescent; Adult; Health Personnel
PubMed: 38922226
DOI: 10.1590/0102-311XEN165023 -
Behavioral Sciences (Basel, Switzerland) Jun 2024This review aims to map studies on governmental and institutional decision-making processes in emergencies. The literature reveals various approaches used by governments... (Review)
Review
This review aims to map studies on governmental and institutional decision-making processes in emergencies. The literature reveals various approaches used by governments in managing emergencies. Consequently, this article suggests the need for a systematic literature review to outline how institutional decision-makers operate during emergencies. To achieve this goal, the most widely used databases in psychological research were consulted, with a specific focus on selecting scientific articles. Subsequently, these studies were rigorously assessed for their relevance using a structured literature selection process following the PRISMA 2020 guidelines. At the conclusion of the review process, nine studies were identified, each suggesting different methods by which governments manage emergencies. This diversity arises because emergency decision-making processes must account for numerous variables that change depending on the type of crisis and the specific context. However, several critical aspects have emerged, such as the centrality of pre-disaster planning to improve intervention practices and methods, attention to information gaps that inevitably arise during an emergency, and the importance of streamlining and delegating decision-making to emergency responders in the field to counter the phenomenon of centralized decision-making that often hampers crucial interventions during emergencies.
PubMed: 38920812
DOI: 10.3390/bs14060481 -
Seminars in Oncology Nursing Jun 2024To explore patient experiences of patient-clinician communication during the critical moments of "breaking bad news" in cancer care. (Review)
Review
Patient Experiences of Patient-Clinician Communication Among Cancer Multidisciplinary Healthcare Professionals During "Breaking Bad News": A Qualitative Systematic Review.
PURPOSE
To explore patient experiences of patient-clinician communication during the critical moments of "breaking bad news" in cancer care.
METHODS
A qualitative systematic review followed the Joanna Briggs Institute methodology and has been reported according to PRISMA guidelines. Databases, including APA PsycINFO, CINAHL, MEDLINE, and Scopus, were searched from the beginning of their date range coverage to April 2023. Data extraction and quality assessment were performed, and a meta-aggregation approach was used for data synthesis.
RESULTS
Twenty-eight studies were included and represented 976 patients. Key themes included (1) sensing something is wrong (prior to diagnosis), (2) reaction to the diagnosis, (3) information (during breaking bad news), (4) communication with health care professionals, (5) specialist versus nonspecialist centers, (6) decision-making, and (7) feeling supported. The review underscores the need for health care professionals to adeptly navigate and respond to individual patient needs during confronting and distressing times.
CONCLUSIONS
The complexity and individuality of patient-clinician communication suggest that further education is needed among the cancer multidisciplinary team to develop personalized, empathetic communication strategies in clinical practice, catering to diverse patient preferences. The findings call for more inclusive research across different cultures and languages, and a need to understand evolving communication needs, especially in the context of increasing digital communication modalities in health care.
IMPLICATIONS FOR CANCER SURVIVORSHIP
This review provides valuable new insights into developing effective communication strategies that are responsive to the diverse needs of patients undergoing cancer treatment. Its findings emphasize the importance of empathy, flexibility, and a personalized approach in delivering bad news and supporting patients throughout survivorship.
PubMed: 38918149
DOI: 10.1016/j.soncn.2024.151680 -
European Heart Journal. Quality of Care... Jun 2024Multiple guidelines exist for the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). We systematically reviewed current guidelines and...
Multiple guidelines exist for the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). We systematically reviewed current guidelines and recommendations, developed by national and international medical organizations, on the management of HFpEF in adults to aid clinical decision-making. We searched MEDLINE and EMBASE on 28 February 2024 for publications over the last 10 years as well as websites of organizations relevant to guideline development. Of the ten guidelines and recommendations retrieved, seven showed considerable rigour of development and were subsequently retained for analysis. There was consensus on the definition of HFpEF and the diagnostic role of serum natriuretic peptides and resting transthoracic echocardiography. Discrepancies were identified in the thresholds of serum natriuretic peptides and transthoracic echocardiography parameters used to diagnose HFpEF. There was agreement on the general pharmacological and supportive management of acute and chronic HFpEF. However, differences exist in strategies to identify and address specific phenotypes. Contemporary guidelines for HFpEF management agree on measures to avoid its development and the consideration of cardiac transplantation in advanced disease. There were discrepancies in recommended frequency of surveillance for patients with HFpEF and sparse recommendations on screening for HFpEF in the general population, use of diagnostic scoring systems, and the role of newly emerging therapies.
PubMed: 38918060
DOI: 10.1093/ehjqcco/qcae053