-
Journal of Ovarian Research Jun 2024This study was aimed to systematically evaluate the efficacy of artificial cycle-prepared frozen-thawed embryo transfer (FET) with or without gonadotrophin-releasing... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This study was aimed to systematically evaluate the efficacy of artificial cycle-prepared frozen-thawed embryo transfer (FET) with or without gonadotrophin-releasing hormone agonist (GnRH-a) pretreatment for women with polycystic ovary syndrome (PCOS).
METHODS
The analysis was carried out by searching the PubMed, EMBASE, and CNKI databases with a combination of keywords before October 2021. The available studies of the effects of GnRH-a pretreatment or no pretreatment on FET in PCOS patients were considered. The risk ratios (RRs) or standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated with using subgroups and sensitivity analysis. The quality evaluation for this analysis was followed.
RESULTS
Seventeen studies including 3646 women were analyzed. GnRH-a pretreatment was significantly associated with a higher implantation rate (RR = 1.12, 95%CI: 1.00-1.24) and clinical pregnancy rate (RR = 1.19, 95%CI: 1.08-1.32) than the placebo. Moreover, in the GnRH-a pretreatment group, significant differences were detected for increasing the endometrium thickness among PCOS patients (SMD = 0.56, 95%CI: 0.20-0.92). However, for RCTs subgroup, no differences were observed, even after sensitivity analyses. In addition, the miscarriage rates, ectopic pregnancy rates, multiple pregnancy rates, and live birth rates were similar in both two groups.
CONCLUSIONS
Endometrial preparation using GnRH agonist pretreatment prior to FET seems to be the better choice for PCOS patients. However, well-designed RCTs are required for confirmation.
Topics: Humans; Polycystic Ovary Syndrome; Female; Embryo Transfer; Gonadotropin-Releasing Hormone; Pregnancy; Pregnancy Rate; Cryopreservation; Fertilization in Vitro
PubMed: 38907340
DOI: 10.1186/s13048-024-01410-7 -
Clinical Kidney Journal Jun 2024Acute kidney injury (AKI) is associated with increased morbidity/mortality. With artificial intelligence (AI), more dynamic models for mortality prediction in AKI...
BACKGROUND
Acute kidney injury (AKI) is associated with increased morbidity/mortality. With artificial intelligence (AI), more dynamic models for mortality prediction in AKI patients have been developed using machine learning (ML) algorithms. The performance of various ML models was reviewed in terms of their ability to predict in-hospital mortality for AKI patients.
METHODS
A literature search was conducted through PubMed, Embase and Web of Science databases. Included studies contained variables regarding the efficacy of the AI model [the AUC, accuracy, sensitivity, specificity, negative predictive value and positive predictive value]. Only original studies that consisted of cross-sectional studies, prospective and retrospective studies were included, while reviews and self-reported outcomes were excluded. There was no restriction on time and geographic location.
RESULTS
Eight studies with 37 032 AKI patients were included, with a mean age of 65.3 years. The in-hospital mortality was 18.0% in the derivation and 15.8% in the validation cohorts. The pooled [95% confidence interval (CI)] AUC was observed to be highest for the broad learning system (BLS) model [0.852 (0.820-0.883)] and elastic net final (ENF) model [0.852 (0.813-0.891)], and lowest for proposed clinical model (PCM) [0.765 (0.716-0.814)]. The pooled (95% CI) AUC of BLS and ENF did not differ significantly from other models except PCM [Delong's test = .022]. PCM exhibited the highest negative predictive value, which supports this model's use as a possible rule-out tool.
CONCLUSION
Our results show that BLS and ENF models are equally effective as other ML models in predicting in-hospital mortality, with variability across all models. Additional studies are needed.
PubMed: 38903953
DOI: 10.1093/ckj/sfae150 -
Frontiers in Neurology 2024Studies of hyperbaric oxygen therapy (HBOT) treatment of mild traumatic brain injury persistent postconcussion syndrome in military and civilian subjects have shown...
BACKGROUND
Studies of hyperbaric oxygen therapy (HBOT) treatment of mild traumatic brain injury persistent postconcussion syndrome in military and civilian subjects have shown simultaneous improvement in posttraumatic stress disorder (PTSD) or PTSD symptoms, suggesting that HBOT may be an effective treatment for PTSD. This is a systematic review and dosage analysis of HBOT treatment of patients with PTSD symptoms.
METHODS
PubMed, CINAHL, and the Cochrane Systematic Review Database were searched from September 18 to November 23, 2023, for all adult clinical studies published in English on HBOT and PTSD. Randomized trials and studies with symptomatic outcomes were selected for final analysis and analyzed according to the dose of oxygen and barometric pressure on symptom outcomes. Outcome assessment was for statistically significant change and Reliable Change or Clinically Significant Change according to the National Center for PTSD Guidelines. Methodologic quality and bias were determined with the PEDro Scale.
RESULTS
Eight studies were included, all with < 75 subjects/study, total 393 subjects: seven randomized trials and one imaging case-controlled study. Six studies were on military subjects, one on civilian and military subjects, and one on civilians. Subjects were 3-450 months post trauma. Statistically significant symptomatic improvements, as well as Reliable Change or Clinically Significant changes, were achieved for patients treated with 40-60 HBOTS over a wide range of pressures from 1.3 to 2.0 ATA. There was a linear dose-response relationship for increased symptomatic improvement with increasing cumulative oxygen dose from 1002 to 11,400 atmosphere-minutes of oxygen. The greater symptomatic response was accompanied by a greater and severe reversible exacerbation of emotional symptoms at the highest oxygen doses in 30-39% of subjects. Other side effects were transient and minor. In three studies the symptomatic improvements were associated with functional and anatomic brain imaging changes. All 7 randomized trials were found to be of good-highest quality by PEDro scale scoring.
DISCUSSION
In multiple randomized and randomized controlled clinical trials HBOT demonstrated statistically significant symptomatic improvements, Reliable Changes, or Clinically Significant Changes in patients with PTSD symptoms or PTSD over a wide range of pressure and oxygen doses. The highest doses were associated with a severe reversible exacerbation of emotional symptoms in 30-39% of subjects. Symptomatic improvements were supported by correlative functional and microstructural imaging changes in PTSD-affected brain regions. The imaging findings and hyperbaric oxygen therapy effects indicate that PTSD can no longer be considered strictly a psychiatric disease.
PubMed: 38882688
DOI: 10.3389/fneur.2024.1360311 -
EBioMedicine Jun 2024Despite promising scalability and accessibility, evidence on the efficacy of self-guided interventions for adult depression is inconclusive. This study investigated...
BACKGROUND
Despite promising scalability and accessibility, evidence on the efficacy of self-guided interventions for adult depression is inconclusive. This study investigated their effectiveness and acceptability, considering diverse delivery formats and support levels.
METHODS
We systematically searched PubMed, PsycINFO, Embase, and Cochrane Library until 1st January 2024. Included were randomised controlled trials comparing self-guided interventions with a control condition for adult depression. Two independent researchers extracted data. Effect sizes were pooled using random-effects models, with post-intervention depressive severity compared with control conditions as the primary outcome. Study validity was evaluated using Cochrane Risk of Bias 2.0. This study was pre-registered with OSF (https://osf.io/rd43v).
FINDINGS
We identified 92 studies (111 interventions vs. control comparisons) with 16,706 participants (mean age: 18.78-74.41 years). Compared to controls, self-guided interventions were moderately effective at post-assessment (g = 0.53, 95% CI: 0.45-0.61; I = 79.17%) and six to twelve months post-randomisation follow-up (g = 0.32, 95% CI: 0.16-0.48; I = 79.19%). Trials with initial human screening (g = 0.59) and interventions delivered in computer programs (g = 1.04) had the significantly largest effect sizes. No differences in treatment effects were observed across support levels, therapy types, commercial availability, or the presence of online discussion forums. Self-guided interventions were less acceptable than control conditions (RR = 0.92, p < 0.001). Most studies showed a moderate to high risk of bias (n = 80).
INTERPRETATION
Existing trials on self-guided interventions are at high risk of bias, potentially overestimating treatment effects. Despite lower acceptability compared to controls, self-guided interventions are moderately effective in treating adult depression, regardless of support levels and online discussion features.
FUNDING
None.
PubMed: 38876043
DOI: 10.1016/j.ebiom.2024.105208 -
BMC Geriatrics Jun 2024Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at... (Meta-Analysis)
Meta-Analysis
Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis.
BACKGROUND
Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults?
METHOD
Eight databases were searched up to December 2, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary -physical activity level -and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects.
RESULTS
The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes.
CONCLUSION
Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals.
TRIAL REGISTRATION
Registration Number: INPLASY202230118.
Topics: Humans; Aged; Walking; Independent Living; Stroke; Risk Factors; Aged, 80 and over; Actigraphy; Health Promotion; Randomized Controlled Trials as Topic; Middle Aged
PubMed: 38872081
DOI: 10.1186/s12877-024-05069-z -
PloS One 2024Involving parents of children with cerebral palsy (C-CP) in home exercise programmes (HEP) is globally practiced strategy closely linked to improved physical performance...
INTRODUCTION
Involving parents of children with cerebral palsy (C-CP) in home exercise programmes (HEP) is globally practiced strategy closely linked to improved physical performance and functional outcomes for the child. Nevertheless, non-adherence to HEP is increasing at an alarming rate, and little is known about the factors influencing adherence to HEP (AHEP) especially in parents of C-CP. This systematic review aimed to identify the factors enhancing AHEP among parents of C-CP to reinforce the efficacy of rehabilitation practices proposed by health professionals, researchers, and educators.
MATERIALS AND METHODS
We conducted searches in PubMed, Scopus, CINHAL, PsycINFO, and Embase for articles published up to March 2023, that investigated the factors influencing AHEP among parents of C-CP. A narrative synthesis was conducted using the search results and pertinent material from other sources.
RESULTS
Overall, non-adherence rates to HEP were moderate to high, ranging from 34% to 79.2%. Strong evidence suggests that factors enhancing AHEP fall into three categories: child-related (such as younger age and better gross motor function [GMF]), the caregiver-related (including high self-efficacy and knowledge, strong social support, low levels of depression, anxiety and stress symptoms, and a low perception of barriers), and the physiotherapist-related. For the latter category, the parent's perception of a supportive and collaborative relationship with the therapist is one of the conditions most favourably influences AHEP.
CONCLUSION
Our findings highlight that factors influencing AHEP are multifactorial. Some, such as GMF or the economic and social conditions of the family, are challenging to change. However, the relationship between therapist and parent is an aspect that can be strengthened. These results underscore the importance of substantial training and psychosocial support for therapists to enhance their awareness and competence in building supportive relationship with parents.
Topics: Humans; Cerebral Palsy; Parents; Child; Exercise Therapy; Social Support; Caregivers; Home Care Services; Patient Compliance
PubMed: 38865337
DOI: 10.1371/journal.pone.0305432 -
Complementary Therapies in Medicine Aug 2024To evaluate the effectiveness of music therapy in reducing anxiety, pain, and vital sign changes in ophthalmic surgery patients. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the effectiveness of music therapy in reducing anxiety, pain, and vital sign changes in ophthalmic surgery patients.
METHODS
An extensive search of databases, including PubMed, Embase, Cochrane, Web of Science, and Google Scholar, identified relevant studies up to Jan 2024. Selection of studies was conducted based on the PICOS criteria. The quality of methodology was assessed using the Cochrane risk-of-bias assessment tool and Review Manager 5.4. Meta-analysis comparing the control group and the music therapy group was performed using R and Stata/SE 15.1 random or fixed effects model.
RESULTS
This meta-analysis included fifteen studies comprising 2098 participants. The analysis revealed that music therapy significantly reduced the risk of high anxiety levels as measured by Visual Analogue Scale (VAS) (I = 0 %, RR(95 %CI): 0.75(0.63, 0.88), p = 0.0006), indicating a substantial effect without heterogeneity. The Anxiety scores determined by State-Trait Anxiety Inventory-State (STAI-S) also showed a significant decrease (SMD(95 %CI): -0.75(-0.88, -0.61), p < 0.0001), albeit with moderate heterogeneity (I² = 36 %). Additionally, music therapy was associated with a reduction in intraoperative pain levels, with no observed heterogeneity (I = 0 %, SMD(95 %CI): -0.74(-0.93, -0.56), p < 0.0001). In contrast, music intervention did not significantly influence self-reported nervousness, relaxation, or satisfaction levels as determined by VAS. Regarding to physiological parameters, a marginal decrease in systolic blood pressure (SBP) was observed (SMD(95 %CI): -0.42(-0.79, -0.04), p = 0.0286), with considerable heterogeneity (I² = 92 %). Diastolic blood pressure (DBP) experienced a slight reduction (I² = 90 %, SMD(95 %CI): -0.45(-0.79, -0.11), p = 0.0088). However, no significant effect was observed on patients' heart rate (p = 0.0864).
CONCLUSION
Music therapy effectively reduced anxiety and pain, and moderately improved vital signs in patients undergoing ophthalmic surgery, highlighting its role in enhancing patient well-being. Further in-depth RCTs are needed to confirm its efficacy.
Topics: Humans; Anxiety; Blood Pressure; Music Therapy; Ophthalmologic Surgical Procedures; Pain Management
PubMed: 38844046
DOI: 10.1016/j.ctim.2024.103062 -
Journal of Dental Anesthesia and Pain... Jun 2024Dental injections are routinely performed and can result in pain and anxiety in patients. This systematic review aimed to evaluate the efficacy of photobiomodulation... (Review)
Review
Dental injections are routinely performed and can result in pain and anxiety in patients. This systematic review aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) in dental injections for pain management in patients undergoing dental treatment. Indexed databases, including PubMed, EMBASE, Scopus, ISI Web of Knowledge, and Cochrane Library, were electronically searched without a time limit up to February 2024. A risk of bias evaluation was performed using the Cochrane tool. A preliminary investigation using electronic and manual methods yielded 4,920,881 manuscripts. Based on the eligibility requirements, 13 randomized control trials (RCTs) were included. Self-assessed pain was determined using the visual analog scale, Face, Legs, Activity, Cry, Controllability scale, or Wong-Baker face pain scale. Eight RCTs demonstrated a notable decrease in needle pain in patients undergoing dental needle injections using PBMT. Based on current evidence, PBMT may help reduce needle pain related to dental anesthesia. Further standardized studies are needed to assess the significance of PBMT for postoperative pain in patients undergoing dental injections.
PubMed: 38840646
DOI: 10.17245/jdapm.2024.24.3.145 -
Journal of the International Society of... Dec 2024Caffeine, widely recognized as an ergogenic aid, has undergone extensive research, demonstrating its effectiveness to enhance endurance performance. However, there... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Caffeine, widely recognized as an ergogenic aid, has undergone extensive research, demonstrating its effectiveness to enhance endurance performance. However, there remains a significant gap in systematically evaluating its effects on time trial (TT) performance in cyclists.
PURPOSE
This meta-analysis aimed to determine the efficacy of caffeine ingestion to increase cycling TT performance in cyclists and to evaluate the optimal dosage range for maximum effect.
METHODS
A search of four databases was completed on 1 December 2023. The selected studies comprised crossover, placebo-controlled investigations into the effects of caffeine ingestion on cycling TT performance. Completion time (Time) and mean power output (MPO) were used as performance measures for TT. Meta-analyses were performed using a random-effects model to assess the standardized mean differences (SMD) in individual studies.
RESULTS
Fifteen studies met the inclusion criteria for the meta-analyses. Subgroup analysis showed that moderate doses of caffeine intake (4-6 mg/kg) significantly improved cycling performance (SMD = -0.55, 95% confidence interval (CI) = -0.84 ~ -0.26, < 0.01, = 35%; SMD = 0.44, 95% CI = 0.09 ~ 0.79, < 0.05, = 39%), while the effects of low doses (1-3 mg/kg) of caffeine were not significant (SMD = -0.34, 95% CI = -0.84 ~ 0.17, = 0.19, = 0%; SMD = 0.31, 95% CI = -0.02 ~ 0.65, = 0.07, = 0%).
CONCLUSION
A moderate dosage (4-6 mg/kg) of caffeine, identified as the optimal dose range, can significantly improve the time trial performance of cyclists, while a low dose (1-3 mg/kg) does not yield improvement. In addition, the improvements in completion time and mean power output resulting from a moderate dose of caffeine are essentially the same in cycling time trails.
Topics: Caffeine; Bicycling; Humans; Athletic Performance; Performance-Enhancing Substances; Dose-Response Relationship, Drug; Physical Endurance
PubMed: 38836626
DOI: 10.1080/15502783.2024.2363789 -
Frontiers in Clinical Diabetes and... 2024Ethnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and...
OBJECTIVE
Ethnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities.
MATERIALS AND METHODS
The major databases were searched for existing qualitative evidence of participants' experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon's Theoretical Framework of Acceptability.
RESULTS
The results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: described participants' satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering and , participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs.
CONCLUSION
Many of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.
PubMed: 38836261
DOI: 10.3389/fcdhc.2024.1306199