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This study aimed to systematically review the literature to synthesise and summarise whether using knowledge-based planning (KBP) can improve the planning of stereotactic radiotherapy treatments.
Methods:
A systematic literature search was carried out using Medline, Scopus and Cochrane databases to evaluate the use of KBP planning in stereotactic radiotherapy. Three hundred twenty-five potential studies were identified and screened to find 25 relevant studies.
Results:
Twenty-five studies met the inclusion criteria. Where a commercial KBP was used, 72.7% of studies reported a quality improvement, and 45.5% reported a reduction in planning time. There is evidence that when used as a quality control tool, KBP can highlight stereotactic plans that need revision. In studies that use KBP as the starting point for radiotherapy planning optimisation, the radiotherapy plans generated are typically equal to or superior to those planned manually.
Conclusions:
There is evidence that KBP has the potential to improve the quality and speed of stereotactic radiotherapy planning. Further research is required to accurately quantify such systems’ quality improvements and time savings. Notably, there has been little research into their use for prostate, spinal or liver stereotactic radiotherapy, and research in these areas would be desirable. It is recommended that future studies use the ICRU 91 level 2 reporting format and that blinded physician review could add a qualitative assessment of KBP system performance.
The aim of this systematic review was to collect evidence and recommendations for the applicability of the concept of evidence-based policy making (EBPM) during the coronavirus disease 2019 (COVID-19) pandemic and to discuss the implementation of this concept from a medical science perspective.
Methods:
This study was performed according to the guidelines, checklist, and flow diagram of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. An electronic literature search was conducted on September 20, 2022 using PubMed, Web of Science, Cochrane Library, and CINAHL databases with the following search terms: “evidence based policy making” and “infectious disease.” Study eligibility assessment was performed based on the flow diagram of PRISMA 2020, and risk of bias assessment was performed using The Critical Appraisal Skills Program.
Results:
Eleven eligible articles were included in this review and divided into three groups as follows: early, middle, and late stages of the COVID-19 pandemic. Basics of COVID-19 control were suggested in the early stage. The articles published in the middle stage discussed the importance of the collection and analysis of evidence of COVID-19 from around the world for the establishment of EBPM in the COVID-19 pandemic. The articles published in the late stage discussed the collection of large amounts of high-quality data and the development of methods to analyze them, as well as emerging issues related to the COVID-19 pandemic.
Conclusions:
This study revealed that the concept of EBPM applicable to emerging infectious disease pandemics changed between the early, middle, and late stages of the pandemic. The concept of EBPM will play an important role in medicine in the future.
Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs.
Methods:
This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed.
Results:
Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure.
Conclusion:
This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.
This systematic review and meta-analysis aimed to investigate the effects of beetroot (BR) or nitrate supplements on body composition indices. A systematic search was conducted for randomized controlled trials (RCTs) published up to August 2022 among online databases including Scopus, PubMed/Medline, Web of Science, and Embase. Meta-analyses were carried out using a random-effects model. The I2 index was used to assess the heterogeneity of RCTs. A total of 12 RCTs met the inclusion criteria for this meta-analysis. The pooled effect size of included studies indicated that BR or nitrate supplementation did not change body weight (WMD: −0.14 kg, 95% CI: −1.22, 1.51; P=0.836; I2 = 0%), body mass index (BMI) (WMD: -0.07 kg/m2, 95% CI: -0.19,0.03; P= 0.174, I2 = 0%), fat mass (FM) (WMD: −0.26 kg, 95% CI: −1.51, 0.98; P= 0.677, I2 = 0%), waist circumference (WC) (WMD: −0.28 cm, 95% CI: −2.30, 1.74; P= 0.786, I2 = 0%), body fat percentage (BFP) (WMD: 0.18%, 95% CI: −0.62, 0.99; P= 0.651, I2 = 0%), fat-free mass (FFM) (WMD: 0.31 kg, 95% CI: −0.31, 1.94; P= 0.703, I2 = 0%), and WHR (WMD: 0, 95% CI: −0.01, 0.02; P= 0.676, I2 = 0%). Subgroup analyses based on trial duration, BR or nitrate dose, study design, baseline BMI, and athletic status (athlete versus nonathlete) demonstrated similar results. Certainty of evidence across outcomes ranged from low to moderate. This meta-analysis study suggests that BR or nitrate supplements cannot efficiently ameliorate body composition indices regardless of supplement dosage, trial duration, and athletic status.
Corticosteroids (CS) and exclusive and partial enteral nutrition (EEN and PEN) are effective therapies in paediatric Crohn’s disease (CD). This systematic review of randomised controlled trials (RCT) and cohort studies analyses the impact of EEN/PEN v. CS on intestinal microbiota, mucosal healing as well as other clinically important outcomes, including clinical remission, relapse, adherence, adverse events and health-related quality of life (HRQL) in paediatric CD. Three RCT (n 76) and sixteen cohort studies (n 1104) compared EEN v. CS. With limited available data (one RCT), the effect on intestinal microbiome indicated a trend towards EEN regarding Shannon diversity. Based on two RCT, EEN achieved higher mucosal healing than CS (risk ratio (RR) 2·36, 95 % CI (1·22, 4·57), low certainty). Compared with CS, patients on EEN were less likely to experience adverse events based on two RCT (RR 0·32, 95 % CI (0·13, 0·80), low certainty). For HRQL, there was a trend in favour of CS based on data from two published abstracts of cohort studies. Based on thirteen cohort studies, EEN achieved higher clinical remission than CS (RR 1·18, 95 % CI (1·02, 1·38), very low certainty). Studies also reported no important differences in relapse and adherence. Compared with CS, EEN may improve mucosal healing with fewer adverse events based on RCT data. While limited data indicate the need for further trials, this is the first systematic review to comprehensively summarise the data on intestinal microbiome, mucosal healing and HRQOL when comparing enteral nutrition and CS in paediatric CD.
Adolescence is a critical time of physical, psychological and social development, and thus, optimal nutritional intakes are required during this life stage. Despite this, adolescence is recognised as a period of nutritional vulnerability, with many reportedly failing to meet current dietary guidelines. The school-setting presents a favourable environment to intervene and promote positive dietary behaviours and is also inclusive regardless of socio-economic status. However, a lack of consensus exists on how best to utilise schools to facilitate improvements in dietary behaviours among this age group. Whilst previous research has focused on identifying the factors motivating dietary choices within the school-setting, less is known on the optimum strategies to enhance these dietary choices which could positively contribute to the design of future interventions. It is reported that adolescents have good nutritional knowledge, although this does not appear to be a central consideration when making their dietary choices. Alternative factors at the individual (taste, visual appeal, familiarity, food quality, price, portion size, value for money, time/ convenience), social (peer influence), physical (product placement) and macro environment (food availability) levels have been frequently cited as important influences on adolescents' dietary choices in school. Although school-based interventions have shown potential in achieving positive dietary change among adolescents, more research is needed to determine the most effective methods in improving dietary behaviours in schools. This review summarises the key factors which influence adolescents' school-based dietary choices and the effectiveness of previously conducted interventions, identifying promising components for consideration when developing future dietary interventions within the school-setting.
Epilepsy, a chronic disease of the central nervous system, is highly prevalent in malaria-endemic regions. Therefore, several studies have evaluated the associations between malaria infection and epilepsy development. A meta-analysis of observational studies published from inception to 10 May 2022 has been conducted to synthesize and pool the existing data on this topic. The relevant publications were systematically searched in PubMed/Medline, Scopus, Embase and Web of Science database collections. A random-effects meta-analysis model (REM) was utilized to generate the pooled odds ratio (OR) at 95% confidence intervals (CIs). The between-studies heterogeneity was assessed with I2, as well as several subgroups, meta-regression and sensitivity analysis were performed to identify the source of heterogeneity. Overall, 17 eligible studies containing 6285 cases and 13 909 healthy controls were included. The REM showed a significant positive association between malaria infection and epilepsy development (OR 2.36; 95% CI 1.44–3.88). In subgroup analyses, significant positive associations were observed in studies that: epilepsy was the outcome in the follow-up of patients with cerebral malaria (OR 7.10; 95% CI 3.50–14.38); used blood smear to diagnose malaria (OR 4.80; 95% CI 2.36–9.77); included only children (OR 3.92; 95% CI 1.81–8.50); published before 2010 (OR 6.39; 95% CI 4.25–9.62). Our findings indicated that patients with malaria, especially those with cerebral malaria, are at a high risk of epilepsy development; however, further well-designed and controlled studies are needed to verify the strength of the association.
The objective of this study was to conduct a systematic review of the scientific literature evaluating the efficacy and comparative efficacy of antimicrobials (AMs) for the treatment of diarrhea in calves. Eligible studies were non- and randomized controlled trials evaluating an AM intervention against a positive and negative control, with at least one of the following outcomes: fecal consistency score, fever, dehydration, appetite, attitude, weight gain, and mortality. Four electronic databases were searched. Titles and abstracts (three reviewers) and full texts (two reviewers) were screened. A total of 2899 studies were retrieved; 11 studies met the inclusion criteria. The risk of bias was assessed. Most studies had incomplete reporting of trial design and results. Eight studies compared AMs to a negative control (placebo or no treatment). Among eligible studies, the most common outcomes reported were diarrhea severity (n = 6) and mortality (n = 6). Eligible studies evaluated very different interventions and outcomes; thus, a meta-analysis was not performed. The risk of bias assessment revealed concerns with reporting of key trial features, including disease and outcome definitions. Insufficient evidence is available in the scientific literature to assess the efficacy of AMs in treating calf diarrhea.
Helminthiases are a class of neglected tropical diseases that affect at least 1 billion people worldwide, with a disproportionate impact on resource-poor areas with limited disease surveillance. Geospatial methods can offer valuable insights into the burden of these infections, particularly given that many are subject to strong ecological influences on the environmental, vector-borne or zoonotic stages of their life cycle. In this study, we screened 6829 abstracts and analysed 485 studies that use maps to document, infer or predict transmission patterns for over 200 species of parasitic worms. We found that quantitative mapping methods are increasingly used in medical parasitology, drawing on One Health surveillance data from the community scale to model geographic distributions and burdens up to the regional or global scale. However, we found that the vast majority of the human helminthiases may be entirely unmapped, with research effort focused disproportionately on a half-dozen infections that are targeted by mass drug administration programmes. Entire regions were also surprisingly under-represented in the literature, particularly southern Asia and the Neotropics. We conclude by proposing a shortlist of possible priorities for future research, including several neglected helminthiases with a burden that may be underestimated.
This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.
This study reviews 71 high-quality studies of massive open online courses focused on languages (LMOOCs) that were published from the inception of LMOOCs to 2021. The purpose of this study is to gain a deeper understanding of the current state of research and identify fruitful directions for future LMOOC research. First, we reviewed three basic sets of characteristics of these studies: (1) research trends – for example, publication types and years; (2) research contexts – for example, countries in which the studies were conducted, the subjects’ target languages, language-ability levels, skills, and whether the focal courses are for specific purposes; and (3) research design, including data collection, data analysis, and theoretical frameworks. We then utilized a text-mining approach called Latent Dirichlet Allocation that uses machine-learning techniques to identify research-topic commonalities underlying the collected studies. In this way, a total of nine topics were identified. They were: (1) core elements of LMOOCs; (2) interaction and communication in LMOOCs; (3) innovative LMOOC teaching practices; (4) LMOOC standards and quality assurance; (5) LMOOC implementation, participation, and completion; (6) LMOOC teaching plans; (7) LMOOC learning effectiveness and its drivers/obstacles; (8) learners and learning in LMOOCs; and (9) inclusiveness in LMOOCs. These were then diagrammed as a ThemeRiver, which showed the evolutionary trend of the nine identified topics. Specifically, scholarly interest in Topics 5, 7, and 9 increased over time, whereas for Topics 1 and 6, it decreased. Based on our results, we highlighted specific directions for future LMOOC research on each of the identified research topics.
This systematic review explores the use of on-animal sensors in sheep and their potential application in objective welfare monitoring. The key questions posed were: To what extent can current scientific knowledge inform a sensor-based approach to welfare evaluations? And, how might this knowledge shape development of commercial monitoring systems? These questions were explored through retrospective classification of published sensor applications using The Five Domains (FD) Model as a framework for animal welfare assessment. A total of 71 studies were reviewed. The results indicate studies specifically evaluating the use of sensors for welfare assessment are limited, though many experiments could still be related to some aspect of welfare. The assessment of sensor utilisation revealed the greatest proportion of applications within the ‘Behaviour’ Domain (90.1%; n = 64), and the lowest within the ‘Health’ (25.4%; n = 18) and ‘Mental state’ Domains (25.4%; n = 18). The review also highlights how different sensor types (location, motion or physiological) differ in their applicability for welfare assessment. This paper is the first to classify published sensor applications using the FD Model as a framework and highlights the potential for sensor technology in sheep welfare monitoring. The results suggest that any attempt to create a commercial sensor-based system for objective welfare assessment will require the integration of more than one sensor type, particularly if multiple Domains are to be addressed.
We conducted a systematic review and meta-analysis on the association between nonword repetition (NWR) and language exposure in bilingual children and explored whether the association is influenced by other variables. We performed a blind literature review on ERIC and Google Scholar, a random-effects model meta-analysis and subgroup analyses to test potential moderators. Out of 822 screened articles, we identified 24 works including 1399 children. Significant associations were found using either cumulative or current exposure, language-like nonwords, phoneme NWR scoring, in children with typical language development. Nonsignificant associations were found in studies either using age of first exposure, on children older than six, with less than 50 participants, using NWR lists containing 16-24 nonwords or with participants having different native languages. Weak associations were found when considering whole-word scoring or gray literature. We highlight the contributions of different variables to NWR, and evidence to optimally design NWR for bilingual language assessment.
The demand of palliative care is increasing due to the aging population and treatment hesitancy or intentional avoidance compromises symptom management.
Objectives
To identify patient beliefs associated with medication hesitancy by using the theory of planned behavior (TPB) namely, attitudes, subjective norms, behavioral intention, and perceived behavioral control associated with medication hesitancy or intentional noncompliance by avoidance.
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed to conduct a systematic literature search involving the CINAHL, Embase, MEDLINE, and PsycINFO databases from inception until March 2022. Hand-searched articles from reference lists and gray literature were included. Thematic analysis was conducted on qualitative data and triangulated with quantitative data.
Results
About 554 articles were retrieved from the literature search and 17 articles were included based on the eligibility criteria. Three subthemes that were identified under TPB constructs were attitude: negative attitude toward medications, passive attitude toward illness and inaccurate information about disease or medication; one subtheme was identified under subjective norms: perceived negative opinions from others; and one subtheme was identified under perceived behavioral control: perception of manageable symptoms. Quantitative data provided triangulation of qualitative findings related to fear of addiction and side effects, feelings of hopelessness, unclear direction and information, social stigma, endurable symptoms, and illness as determinants for medication avoidance.
Significance of results
This systematic review highlighted some patient beliefs related to medication hesitancy or avoidance. Clinicians should take patient beliefs and concerns into consideration when creating treatment regimens for people receiving palliative care to optimize medication adherence and the quality of care.
Several in-person and remote delivery formats of cognitive-behavioural therapy (CBT) for panic disorder are available, but up-to-date and comprehensive evidence on their comparative efficacy and acceptability is lacking. Our aim was to evaluate the comparative efficacy and acceptability of all CBT delivery formats to treat panic disorder. To answer our question we performed a systematic review and network meta-analysis of randomised controlled trials. We searched MEDLINE, Embase, PsycINFO, and CENTRAL, from inception to 1st January 2022. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO. We found a total of 74 trials with 6699 participants. Evidence suggests that face-to-face group [standardised mean differences (s.m.d.) −0.47, 95% confidence interval (CI) −0.87 to −0.07; CINeMA = moderate], face-to-face individual (s.m.d. −0.43, 95% CI −0.70 to −0.15; CINeMA = Moderate), and guided self-help (SMD −0.42, 95% CI −0.77 to −0.07; CINeMA = low), are superior to treatment as usual in terms of efficacy, whilst unguided self-help is not (SMD −0.21, 95% CI −0.58 to −0.16; CINeMA = low). In terms of acceptability (i.e. all-cause discontinuation from the trial) CBT delivery formats did not differ significantly from each other. Our findings are clear in that there are no efficacy differences between CBT delivered as guided self-help, or in the face-to-face individual or group format in the treatment of panic disorder. No CBT delivery format provided high confidence in the evidence at the CINeMA evaluation.
This systematic literature review surveyed the evidence for the acceptability and effectiveness of CBT and psychologically based interventions for emergency department (ED) attenders with physical health complaints as their primary concern, in light of over-burdened EDs and the existing evidence base for psychological interventions in other medical settings. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018087860). A systematic search of three databases (APAPsychNet, Cochrane and PubMed) was performed to identify psychological treatment studies targeting physical health problems presenting in the ED, with broad inclusion criteria to capture a coherent understanding of the current knowledge base. A total of 2606 potential studies for inclusion were identified; 45 proceeded to full review. Twenty papers met the full inclusion. Included studies covered four clinical areas: trauma/PTSD-prevention, panic attacks, non-cardiac chest-pain and miscellaneous. A narrative description of findings reflected positive outcomes across all groups, but this was not consistent across any group. Few studies measured ED attendance (20%) or satisfaction/acceptability (10%). The majority of studies (90%) were underpinned by a cognitive behavioural framework, consistent with the current evidence base as applied to the management of medical conditions. Findings suggest there is some evidence that interventions in the ED are effective and acceptable to patients, but interpretation of findings is limited by the mixed quality of designs and risk of bias.
Key learning aims
(1) To understand the current body of evidence for the feasibility and effectiveness of psychological interventions in the emergency department.
(2) To gain a clear understanding of the models and format of the delivery of CBT and psychological interventions in an acute setting.
(3) To identify gaps in the evidence to inform future development of CBT-based interventions to improve outcomes and clinical care.
We evaluated associations between food insecurity (FI) and the quality and quantity of sleep in adults (≥18 years).
Design:
The current study represented a systematic review and meta-analysis of observational studies.
Setting:
Databases of PubMed, Scopus, Embase and Web of Science were searched from inception until 6 June 2022. Meta-analyses were conducted using random-effects models, and effect sizes were reported as OR and 95 % CI.
Participants:
Data from ten eligible observational studies, including 83 764 participants, were included.
Results:
FI was associated with an increased risk of poor sleep quality (OR = 1·45; 95 % CI (1·24, 1·70), I2 = 95, P < 0·001, n 7). Besides, subgroup analysis showed increased risk of poor sleep quality corresponding to the severity of FI across mild (OR = 1·31; 95 % CI (1·16, 1·48), I2 = 0 %, P < 0·001, n 5), moderate (OR = 1·49; 95 % CI (1·32, 1·68), I2 = 0 %, P < 0·001, n 5) and severe (OR = 1·89; 95 % CI (1·63, 2·20), I2 = 0 %, P < 0·001, n 5) levels. Similarly, subgroup analysis by sleep problems showed that FI was associated with an increased the risk of trouble falling asleep (OR = 1·39; 95 % CI (1·05, 1·83), I2 = 91 %, P = 0·002, n 3) and trouble staying asleep (OR = 1·91; 95 % CI (1·37, 2·67), I2 = 89 %, P < 0·001, n 3). Moreover, FI was associated with the odds of shorter (OR = 1·14; 95 % CI (1·07, 1·21), I2 = 0 %, P < 0·001, n 4) and longer sleep duration (OR = 1·14; 95 % CI (1·03, 1·26), I2 = 0 %, P = 0·010, n 4).
Conclusions:
Collective evidence supports that FI is associated with poor sleep quality and quantity in adults. Preventative and management strategies that address FI may provide health benefits beyond improving nutritional status per se.
Individuals with autism spectrum disorder (ASD) struggle accessing psychotherapy services for comorbidities, including anxiety-, depressive- and obsessive-compulsive disorders (OCD). Apart from cognitive behavioural therapy (CBT) for anxiety in children with ASD, it is unclear whether psychotherapy is effective for these comorbid disorders.
We therefore systematically reviewed any form of psychotherapy for co-occurring symptoms of anxiety, depression and OCD in individuals with ASD.
Database searches were conducted until February 2022 using EMBASE, PsycINFO and PubMed. Randomised controlled trials (RCT) were included investigating any form of psychotherapy for symptoms of anxiety, depression and OCD in individuals with ASD. Summary data were extracted, and random-effects meta-analyses were conducted.
For CBT 26 RCTs (n = 1251), and for social skills training (SST) 11 RCTs (n = 475) met criteria for inclusion. Pooled effect sizes indicated a moderate reduction of anxiety in children (g = −0.70) and a small reduction of depressive symptoms in adults (g = −0.39). For SST overall effect sizes were small for reduction of anxiety in children (g = −0.35) and adults (g = −0.34) and moderate for reduction of depressive symptoms in children (g = −0.50). Risk of bias was high in 18, moderate in 16 and low in 3 RCTs.
Our results provide new and age-specific evidence that: (1) CBT is effective for reducing anxiety in children and to a lesser extent for depressive symptoms in adults with ASD; and (2) social skills interventions are effective for reducing anxiety in children and adults and for depressive symptoms in children with ASD.