Systematic reviews are difficult to keep up to date, but failure to do so leads to a decay in review currency, accuracy, and utility. We are developing a novel approach to systematic review updating ...termed “Living systematic review” (LSR): systematic reviews that are continually updated, incorporating relevant new evidence as it becomes available. LSRs may be particularly important in fields where research evidence is emerging rapidly, current evidence is uncertain, and new research may change policy or practice decisions. We hypothesize that a continual approach to updating will achieve greater currency and validity, and increase the benefits to end users, with feasible resource requirements over time.
BackgroundThe British Thoracic Society Pleural guidelines recommend attempting pleurodesis in patients with malignant pleural effusion (MPE) whose chest X-rays show evidence of less than 50% lung ...entrapment,1 suggesting that more extensive entrapment would predict pleurodesis failure. It is not clear, however, how far the extent of pleural involvement by malignancy affects pleurodesis outcome.MethodsA systematic review of papers available on PubMed, Embase and Cochrane databases published in English on the subject of pleurodesis was carried out(protocol CRD42018115874). Only papers with clear definition of pleurodesis success with 20 or more patients were included.ResultsThe search returned 972 titles. Six papers (reporting on 1155 patients) studying MPE due to different primaries contained data on the relation between tumour burden assessed during thoracoscopic examination of the pleural cavity. Five of the included papers utilised a score developed previously.2Table 1 summarises the included studies and the effect measures reported. There was no uniform way of interpreting the results of the pleural burden score.ConclusionOnly papers of retrospective design linked higher pleural tumour burden with pleurodesis failure. More robust evidence is required from prospectively designed studies.ReferencesRoberts, et al. Thorax 2010;65:ii32–40.Sanchez-Armengol A, et al. Chest 1993;104:1482–5.Abstract P105 Table 1
OBJECTIVE: To quantify the association between prophylactic radiologic interventions and perioperative blood loss during cesarean delivery in women with placenta accreta spectrum disorder through a ...systematic review and network meta-analysis. DATA SOURCES: On January 3, 2023, a literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science. We also checked ClinicalTrials.gov retrospectively. Prophylactic radiologic interventions to reduce bleeding during cesarean delivery involved preoperative placement of balloon catheters, distal (internal or common iliac arteries) or proximal (abdominal aorta), or sheaths (uterine arteries). The primary outcome was volume of blood loss; secondary outcomes were the number of red blood cell units transfused and adverse events. Studies including women who received an emergency cesarean delivery were excluded. METHODS OF STUDY SELECTION: Two authors independently screened citations for relevance, extracted data, and assessed the risk of bias of individual studies with the Cochrane Risk of Bias in Non-randomized Studies of Interventions tool. TABULTATION, INTEGRATION, AND RESULTS: From a total of 1,332 screened studies, 50 were included in the final analysis, comprising 5,962 women. These studies consisted of two randomized controlled trials and 48 observational studies. Thirty studies compared distal balloon occlusion with a control group, with a mean difference in blood loss of −406 mL (95% CI, −645 to −167). Fourteen studies compared proximal balloon occlusion with a control group, with a mean difference of −1,041 mL (95% CI, −1,371 to −710). Sensitivity analysis excluding studies with serious or critical risk of bias provided similar results. Five studies compared uterine artery embolization with a control group, all with serious or critical risk of bias; the mean difference was −936 mL (95% CI, −1,522 to −350). Reported information on adverse events was limited. CONCLUSION: Although the predominance of observational studies in the included literature warrants caution in interpreting the findings of this meta-analysis, our findings suggest that prophylactic placement of balloon catheters or sheaths before planned cesarean delivery in women with placenta accreta spectrum disorder may, in some cases, substantially reduce perioperative blood loss. Further study is required to quantify the efficacy according to various severities of placenta accreta spectrum disorder and the associated safety of these radiologic interventions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022320922.
This study presents a systematic review of the literature on augmented reality (AR) used in educational settings. We consider factors such as publication year, learner type (e.g., K-12, higher ...education, and adult), technologies in AR, and the advantages and challenges of using AR in educational settings. The full range of SSCI journals was surveyed and a total of 68 research articles were selected for analysis. The findings reveal an increase in the number of AR studies during the last four years. The most reported advantage of AR is that it promotes enhanced learning achievement. Some noted challenges imposed by AR are usability issues and frequent technical problems. We found several other challenges and numerous advantages of AR usage, which are discussed in detail. In addition, current gaps in AR research and needs in the field are identified, and suggestions are offered for future research.
•We conducted a systematic review of literature on AR used in educational settings.•Numerous studies have indicated that AR promotes enhanced learning performance.•The most reported challenge is that AR is difficult for students to use.•Most of the problems were experienced in location-based AR applications.
Overviews of systematic reviews (SRs) attempt to systematically retrieve and summarise the results of multiple systematic reviews. This is the second of two papers from a study aiming to develop a ...comprehensive evidence map of the methods used in overviews. Our objectives were to (a) develop a framework of methods for conducting, interpreting and reporting overviews (stage I)-the Methods for Overviews of Reviews (MOoR) framework-and (b) to create an evidence map by mapping studies that have evaluated overview methods to the framework (stage II). In the first paper, we reported findings for the four initial steps of an overview (specification of purpose, objectives and scope; eligibility criteria; search methods; data extraction). In this paper, we report the remaining steps: assessing risk of bias; synthesis, presentation and summary of the findings; and assessing certainty of the evidence arising from the overview.
In stage I, we identified cross-sectional studies, guidance documents and commentaries that described methods proposed for, or used in, overviews. Based on these studies, we developed a framework of possible methods for overviews, categorised by the steps in conducting an overview. Multiple iterations of the framework were discussed and refined by all authors. In stage II, we identified studies evaluating methods and mapped these evaluations to the framework.
Forty-two stage I studies described methods relevant to one or more of the latter steps of an overview. Six studies evaluating methods were included in stage II. These mapped to steps involving (i) the assessment of risk of bias (RoB) in SRs (two SRs and three primary studies, all reporting evaluation of RoB tools) and (ii) the synthesis, presentation and summary of the findings (one primary study evaluating methods for measuring overlap).
Many methods have been described for use in the latter steps in conducting an overview; however, evaluation and guidance for applying these methods is sparse. The exception is RoB assessment, for which a multitude of tools exist-several with sufficient evaluation and guidance to recommend their use. Evaluation of other methods is required to provide a comprehensive evidence map.
OBJECTIVE: To systematically review the evidence for the effectiveness and safety of magnesium sulfate as a fetal neuroprotective agent when given to individuals at risk of preterm birth. DATA ...SOURCES: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (through March 17, 2023), and reference lists of relevant studies. METHODS OF STUDY SELECTION: Randomized controlled trials (RCTs) assessing magnesium sulfate for fetal neuroprotection in pregnant participants at risk of imminent preterm birth were eligible. Two authors assessed RCTs for inclusion, extracted data, and evaluated risk of bias, trustworthiness, and evidence certainty (GRADE Grading of Recommendations Assessment, Development and Evaluation). TABULATION, INTEGRATION, AND RESULTS: We included six RCTs (5,917 pregnant participants and 6,759 fetuses at less than 34 weeks of gestation at randomization). They were conducted in high-income countries (two in the United States, two across Australia and New Zealand, and one each in Denmark and France) and commenced between 1995 and 2018. Primary outcomes: up to 2 years of corrected age, magnesium sulfate compared with placebo reduced the risk of cerebral palsy (risk ratio RR 0.71, 95% CI, 0.57–0.89; six RCTs, 6,107 children) and death or cerebral palsy (RR 0.87, 95% CI, 0.77–0.98; six RCTs, 6,481 children) (high-certainty evidence). Magnesium sulfate had little or no effect on death up to 2 years of corrected age (moderate-certainty evidence) or these outcomes at school age (low-certainty evidence). Although there was little or no effect on death or cardiac or respiratory arrest for pregnant individuals (low-certainty evidence), magnesium sulfate increased adverse effects severe enough to stop treatment (RR 3.21, 95% CI, 1.88–5.48; three RCTs, 4,736 participants; moderate-certainty evidence). Secondary outcome: magnesium sulfate reduced the risk of severe neonatal intraventricular hemorrhage (moderate-certainty evidence). CONCLUSION: Magnesium sulfate for preterm fetal neuroprotection reduces cerebral palsy and death or cerebral palsy for children. Further research is required on longer-term benefits and harms for children, effect variation by participant and treatment characteristics, and the generalizability of findings to low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION: The review protocol was based on a standard Cochrane Pregnancy and Childbirth template and our previous Cochrane Systematic Review (doi: 10.1002/14651858.CD004661.pub3; published before the introduction of PROSPERO).
ABSTRACT Background: Modalities to improve tissue acquisition during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been investigated. Endobronchial ...ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) is a modality to obtain larger histological samples by inserting a cryoprobe into the mediastinal lesion. We aimed to study the diagnostic yield and safety of EBUS-TMC. Methods: We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yield of EBUS-TMC and compare it with EBUS-TBNA. Results: Following a systematic search, we identified 14 relevant studies (869 patients undergoing EBUS-TMC and EBUS-TBNA). We then performed a meta-analysis of the diagnostic yield of EBUS-TMC and EBUS-TBNA from studies wherein both procedures were performed. The pooled diagnostic yield of EBUS-TMC was 92% (95% confidence interval CI, 89%–95%). The pooled diagnostic yield of EBUS-TBNA was 81% (95% CI, 77%–85%). The risk difference in yield was 11% (95% CI, 6%–15%, I 2 = 0%) when EBUS-TMC and EBUS-TBNA were compared. The only complication reported commonly with EBUS-TMC was minor bleeding. The complication rate was comparable with EBUS-TBNA. Conclusion: EBUS-TMC provides a greater diagnostic yield with a similar risk of adverse events compared to EBUS-TBNA. Future studies are required to clearly establish which patients are most likely to benefit from this modality.
This study aimed to analyze the determinants of neonatal mortality over the last decade (2013-2023), identifying key factors that have influenced neonatal outcomes both before and during the COVID-19 ...pandemic. Utilizing a systematic literature review approach guided by the PRISMA method, this study evaluates 91 papers collected from indexed databases such as Scopus, PubMed, and Web of Science. The review encompasses studies conducted globally, offering insights into the evolution of neonatal mortality research and the impact of the COVID-19 crisis on neonatal health. The analysis revealed a complex array of risk determinants, categorized into socioeconomic factors, clinical factors, and healthcare access and quality. Notable factors include rural versus urban healthcare disparities, prenatal and postnatal care quality, and the influence of healthcare infrastructure on neonatal outcomes. This study highlights the shifting focus of neonatal mortality research in response to global health challenges, including the pandemic. The findings underscore the need for multidisciplinary approaches to address neonatal mortality, emphasizing the importance of enhancing healthcare systems, improving maternal education, and ensuring equitable access to quality care. Future research should explore the long-term effects of the COVID-19 pandemic on neonatal health and investigate the efficacy of interventions in diverse healthcare settings.This study aimed to analyze the determinants of neonatal mortality over the last decade (2013-2023), identifying key factors that have influenced neonatal outcomes both before and during the COVID-19 pandemic. Utilizing a systematic literature review approach guided by the PRISMA method, this study evaluates 91 papers collected from indexed databases such as Scopus, PubMed, and Web of Science. The review encompasses studies conducted globally, offering insights into the evolution of neonatal mortality research and the impact of the COVID-19 crisis on neonatal health. The analysis revealed a complex array of risk determinants, categorized into socioeconomic factors, clinical factors, and healthcare access and quality. Notable factors include rural versus urban healthcare disparities, prenatal and postnatal care quality, and the influence of healthcare infrastructure on neonatal outcomes. This study highlights the shifting focus of neonatal mortality research in response to global health challenges, including the pandemic. The findings underscore the need for multidisciplinary approaches to address neonatal mortality, emphasizing the importance of enhancing healthcare systems, improving maternal education, and ensuring equitable access to quality care. Future research should explore the long-term effects of the COVID-19 pandemic on neonatal health and investigate the efficacy of interventions in diverse healthcare settings.
A BSTRACT Background: Polycystic ovarian syndrome (PCOS) is a gynaecological problem affecting women within reproductive age, accompanied by several metabolic anomalies, thus leading to alteration in ...kidney function and hyperuricaemia. Due to the high prevalence of cardiometabolic factors in PCOS, there is a need to anticipate an increased number of kidney impairments amongst these women. Objectives: This review aims to investigate the potential link between PCOS, impaired kidney function, and elevated uric acid levels. By elucidating this association, we hope to provide clinicians with a tool to stratify the risk of kidney disease in women diagnosed with PCOS, based on readily available kidney function parameters. Materials and Methods: The recommendations used for the analysis were outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Subsequently, eligible studies were identified using several databases (MEDLINE, ProQuest and EBSCOhost) between 1996 and 2022, with a total of 13 studies included. Serum uric acid, serum creatinine, as well as estimated glomerular filtration rate (eGFR) were evaluated as the outcome of interest. Quality assessment for cohort, case–control and cross-sectional studies was conducted utilising the Newcastle–Ottawa Scale, while Review Manager 5.4 was utilised for meta-analysis. Results: Uric acid was significantly higher in women with PCOS (mean difference MD = 0.70, 95% confidence interval CI 0.45–0.95, P < 0.00001). Meanwhile, serum creatinine and eGFR were statistically similar in each group (MD = 0.08, 95% CI −0.05–0.21, P = 0.22 and MD = 3.54, 95% CI −4.53–11.61, P = 0.39, respectively). Interpretation: This review showed that PCOS was significantly associated with elevated uric acid. However, no significant difference was found between eGFR and creatinine levels compared to healthy controls. Routine uric acid assessment in PCOS patients is recommended as a simple tool for risk stratification. Limitations: No body mass index (BMI) subgroup analysis was done due to limited BMI reporting in our included studies. Quantitative analysis of all kidney function parameters was also limited by sparse data on urea and albumin. PROSPERO Registration Number: CRD42023410092 (02 April 2023).
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