Systematic reviews (SRs) are time and resource intensive, requiring approximately 1 year from protocol registration to submission for publication. Our aim was to describe the process, facilitators, ...and barriers to completing the first 2-week full SR.
We systematically reviewed evidence of the impact of increased fluid intake, on urinary tract infection (UTI) recurrence, in individuals at risk for UTIs. The review was conducted by experienced systematic reviewers with complementary skills (two researcher clinicians, an information specialist, and an epidemiologist), using Systematic Review Automation tools, and blocked off time for the duration of the project. The outcomes were time to complete the SR, time to complete individual SR tasks, facilitators and barriers to progress, and peer reviewer feedback on the SR manuscript. Times to completion were analyzed quantitatively (minutes and calendar days); facilitators and barriers were mapped onto the Theoretical Domains Framework; and peer reviewer feedback was analyzed quantitatively and narratively.
The SR was completed in 61 person-hours (9 workdays; 12 calendar days); accepted version of the manuscript required 71 person-hours. Individual SR tasks ranged from 16 person-minutes (deduplication of search results) to 461 person-minutes (data extraction). The least time-consuming SR tasks were obtaining full-texts, searches, citation analysis, data synthesis, and deduplication. The most time-consuming tasks were data extraction, write-up, abstract screening, full-text screening, and risk of bias. Facilitators and barriers mapped onto the following domains: knowledge; skills; memory, attention, and decision process; environmental context and resources; and technology and infrastructure. Two sets of peer reviewer feedback were received on the manuscript: the first included 34 comments requesting changes, 17 changes were made, requiring 173 person-minutes; the second requested 13 changes, and eight were made, requiring 121 person-minutes.
A small and experienced systematic reviewer team using Systematic Review Automation tools who have protected time to focus solely on the SR can complete a moderately sized SR in 2 weeks.
IntroductionThis review determined the effectiveness of female anorgasmia treatments in premenopausal women using a systematic search strategy. This review considers all physiological, ...pharmaceutical, psychological and social treatments. Thomas and Thurston (Maturitas 2016; 87 49-60) recommend a biopsychosocial approach, where subjective distress and physical factors can coexist (Brotto et al. JSM 2010; 586-614). Yet, methodological issues are rife e.g., obtaining representative samples and limited assessment methods. Further, reviews are narrative with limited synthesis (Marchand SMR 2021; 9(2) 194-211). Frühauf et al. (Archives of Sexual Behavior 2013; 42(6) 915-933) completed a review, but there is no account for research published after 2007 and limited follow-up assessments.ObjectivesThis is the first systematic review of premenopausal anorgasmia with assessment of bias for all treatments. This review is restricted to anorgasmia to better isolate interventions and exclude comorbid conditions.Methods10 different databases were searched (2007-2021) including studies from peer-reviewed journal articles and grey literature. Results were synthesised in forest plots according to timepoints of data, alongside different treatments to determine effect size from standardised mean differences (SMD). Outcome measures included the self-reported sexual function, sexual distress and clinician observation. The SMD was used as not all scales are consistent across studies. All results given are in line with a pre-defined analysis plan.ResultsOf 1388 studies screened, 15 studies (2002-2020) were analysed: study designs were mixed with mostly self-report measures. Effective treatments included Tribulus terrestris (M=3.77, p<0.01), plasma injection (M=4.48, p<0.01), and CO2 laser therapy (M=4.06, p<0.05). For psychological studies, assessment of active sexual engagement described how subjects felt more aware of their sexuality which improved outcomes. Limitations of most studies included a very high risk of bias, notably in randomisation of subjects, allocation and outcomes. All interventions had a significant effect in independent t-tests, yet synthesis of SMDs show insignificant effect, implying data is inconclusive.ConclusionsThis review aimed to systematically appraise all treatments for orgasmic satisfaction for premenopausal women. Higher levels of significance were observed for treatments across all modalities. The efficacy of natural supplements has been disputed (IsHak et al. JSM 2010; 7(10) 3254-3268), but this review shows promise. All psychological results provided insight into the role of the therapist-client relationship and reappraisal of traumatic sexual experience. Yet, risk of bias is likely impacted by difficulty establishing standardised scientific protocol. Considerations for future research include clear statements of randomisation and multi-faceted outcome measures.Disclosure of InterestNone Declared
Background: Anthracycline-taxane is the standard chemotherapy strategy for treating high-risk early breast cancer despite the potentially life-threatening adverse events caused by anthracyclines. ...Commonly, the combination of docetaxel and cyclophosphamide (TC) is considered an alternative option. However, the efficacy of TC compared to anthracycline-taxane chemotherapy is unclear. This study compares disease-free survival (DFS), overall survival (OS) and cardiotoxicity between adjuvant TC and anthracycline-taxane for stages I–III, HER2-negative breast cancer. Methods: A systematic search on MEDLINE, Embase and Cochrane CENTRAL for randomized-controlled trials published until 11 March 2024, yielded 203 studies with 11,803 patients, and seven trials were included. Results: TC results in little to no difference in DFS (HR 1.09, 95% CI 0.98–1.20; moderate-certainty of evidence); OS (1.02, 95% CI 0.89–1.16; high-certainty of evidence); and cardiotoxicity (RR 0.54, 95% CI 0.16–1.76; high-certainty of evidence), compared to anthracycline-taxane. In the subgroup analysis, patients with ≥4 lymph nodes had improved DFS from anthracycline-taxane over TC. Conclusions: Overall, there was no difference between TC and anthracycline-taxane in DFS, OS and cardiotoxicity. In women with ≥4 nodes, anthracycline-taxane was associated with a substantial reduction in relapse events, compared to TC. Our study supports the current standard of practice, which is to use anthracycline-taxane and TC chemotherapy as a reasonable option in select cases.
Chimeric Antigen Receptor T-cell (CAR-T) therapy uses genetically engineered T-cells with specific binding sites. This therapy allows for tumor specificity and durable treatment responses for ...patients with hematological malignancies. In this review, we study the risk of venous thromboembolism (VTE) associated with CAR-T therapy. We searched the National Institutes of Health library, Cochrane Library Databases, ClinicalTrials.gov database, and medical literature search engines PubMed and Google Scholar for Phase 2 and Phase 3 drug-efficacy and safety trials to determine the aggregate incidence and risk of VTE treated with CAR-T. Of 1127 search results, nine studies were identified and included in our meta-analysis. Of the 1017 patients who received therapy, 805 patients (79.15%) experienced some degree of CRS, and 122 patients (11.9%) experienced severe CRS (higher than grade 3). Only three out of one thousand and seventeen patients were reported to have experienced venous thromboembolism. Our study did not find a statistically significant association between increased VTE incidence (OR = 0.0005, 95% CI 0.0001, 0.0017) and CRS/ICANS (p < 0.0001). There was a 0.0050 (95% confidence interval 0.0019, 0.0132) relative risk for VTE. In our study, we did not find a statistically significantly increased risk of developing VTE despite CRS and underlying malignancy, which have been associated with increased risk of VTE.
Children with disabilities experience poorer oral health and frequently have complex needs. The accessibility of oral health care services for children with disabilities is crucial for promoting oral ...health and overall well-being. This study aimed to systematically review the literature to identify the barriers and facilitators to oral health care services for children with disabilities, and to propose priority research areas for the planning and provision of dental services to meet their needs.BACKGROUNDChildren with disabilities experience poorer oral health and frequently have complex needs. The accessibility of oral health care services for children with disabilities is crucial for promoting oral health and overall well-being. This study aimed to systematically review the literature to identify the barriers and facilitators to oral health care services for children with disabilities, and to propose priority research areas for the planning and provision of dental services to meet their needs.This was a mixed methods systematic review. Multiple databases searched included MEDLINE, Scopus, PsycINFO, EMBASE, and CINAHL. The search strategy included Medical Subject Heading (MeSH) terms related to children, disabilities, and access to oral health. Eligibility criteria focused on studies about children with disabilities, discussing the accessibility of oral health care.METHODSThis was a mixed methods systematic review. Multiple databases searched included MEDLINE, Scopus, PsycINFO, EMBASE, and CINAHL. The search strategy included Medical Subject Heading (MeSH) terms related to children, disabilities, and access to oral health. Eligibility criteria focused on studies about children with disabilities, discussing the accessibility of oral health care.Using Levesque's framework for access identified barriers such as professional unwillingness, fear of the dentist, cost of treatment, and inadequate dental facilities. Facilitators of access offered insight into strategies for improving access to oral health care for children with disabilities.RESULTSUsing Levesque's framework for access identified barriers such as professional unwillingness, fear of the dentist, cost of treatment, and inadequate dental facilities. Facilitators of access offered insight into strategies for improving access to oral health care for children with disabilities.There is a positive benefit to using Levesque's framework of access or other established frameworks to carry out research on oral healthcare access, or implementations of dental public health interventions in order to identify gaps, enhance awareness and promote better oral health practices. The evidence suggests that including people with disabilities in co-developing service provision improves accessibility, alongside using tailored approaches and interventions which promote understanding of the importance of dental care and increases awareness for professionals, caregivers and children with disabilities.CONCLUSIONThere is a positive benefit to using Levesque's framework of access or other established frameworks to carry out research on oral healthcare access, or implementations of dental public health interventions in order to identify gaps, enhance awareness and promote better oral health practices. The evidence suggests that including people with disabilities in co-developing service provision improves accessibility, alongside using tailored approaches and interventions which promote understanding of the importance of dental care and increases awareness for professionals, caregivers and children with disabilities.Protocol has been registered online on the PROSPERO database with an ID CRD42023433172 on June 9, 2023.TRIAL REGISTRATIONProtocol has been registered online on the PROSPERO database with an ID CRD42023433172 on June 9, 2023.
The administration of tranexamic acid (TXA) during spinal surgery has been shown to reduce blood loss. However, the efficacy and safety of intravenous TXA (ivTXA) and topical TXA (tTXA) are poorly ...documented. The present meta-analysis aimed to compare the efficacy and safety of ivTXA and tTXA administration in spinal surgery.BACKGROUNDThe administration of tranexamic acid (TXA) during spinal surgery has been shown to reduce blood loss. However, the efficacy and safety of intravenous TXA (ivTXA) and topical TXA (tTXA) are poorly documented. The present meta-analysis aimed to compare the efficacy and safety of ivTXA and tTXA administration in spinal surgery.Potentially relevant academic articles were identified from PubMed, Ovid, Cochrane Library, CNKI database, and Wanfang Data from the date of inception until March 1, 2024. Randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs) were included in our meta-analysis if they compared the efficacy and safety of ivTXA versus tTXA administration during spinal surgery. Secondary sources were identified from the references of the included literature. The meta-analysis was performed in accordance with the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Data were summarized using RevMan 5.3 software from Denmark.METHODSPotentially relevant academic articles were identified from PubMed, Ovid, Cochrane Library, CNKI database, and Wanfang Data from the date of inception until March 1, 2024. Randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs) were included in our meta-analysis if they compared the efficacy and safety of ivTXA versus tTXA administration during spinal surgery. Secondary sources were identified from the references of the included literature. The meta-analysis was performed in accordance with the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Data were summarized using RevMan 5.3 software from Denmark.Four RCTs and one non-RCT met our inclusion criteria. The pooled outcomes demonstrated that ivTXA groups compared with tTXA groups had significantly less amount of total blood loss weighted mean difference (WMD)=-159.55, 95% CI (-181.91,-137.19), P < 0.00001, hidden blood loss WMD=-132.27, 95% CI (-159.81, -104.72), P < 0.00001, intraoperative blood loss WMD=-86.22, 95% CI (-99.13, -73.31), P < 0.00001, I2 = 96%, and more high postoperative hemoglobin level WMD = 8.96, 95% CI (5.18, 12.75), P < 0.00001, I2 = 29%, and less transfusion rate risk ratio (RR) = 1.11, 95% CI (0.81,1.52), P = 0.50, I2 = 94%. The pooled results showed no significant difference in thromboembolic events (deep venous thrombosis and pulmonary embolism) between the two groups.RESULTSFour RCTs and one non-RCT met our inclusion criteria. The pooled outcomes demonstrated that ivTXA groups compared with tTXA groups had significantly less amount of total blood loss weighted mean difference (WMD)=-159.55, 95% CI (-181.91,-137.19), P < 0.00001, hidden blood loss WMD=-132.27, 95% CI (-159.81, -104.72), P < 0.00001, intraoperative blood loss WMD=-86.22, 95% CI (-99.13, -73.31), P < 0.00001, I2 = 96%, and more high postoperative hemoglobin level WMD = 8.96, 95% CI (5.18, 12.75), P < 0.00001, I2 = 29%, and less transfusion rate risk ratio (RR) = 1.11, 95% CI (0.81,1.52), P = 0.50, I2 = 94%. The pooled results showed no significant difference in thromboembolic events (deep venous thrombosis and pulmonary embolism) between the two groups.Our meta-analysis demonstrated that ivTXA was more effective than tTXA in inducing hemostatic effect during spinal surgery. However, the risk of a thrombotic event was not different between the two administration methods of TXA. More high quality RCTs are needed to further confirm our conclusions.CONCLUSIONOur meta-analysis demonstrated that ivTXA was more effective than tTXA in inducing hemostatic effect during spinal surgery. However, the risk of a thrombotic event was not different between the two administration methods of TXA. More high quality RCTs are needed to further confirm our conclusions.
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