OBJECTIVE: To systematically evaluate and re-evaluate the surgical outcomes of robotic-assisted total knee arthroplasty(RA-TKA) compared with to conventional total knee arthroplasty(C-TKA). METHODS: Ten databases, including PubMed, EmBase, Web of Science, Cochrane Library, CINAHL, JBI, CNKI, Wanfang, VIP, CBM, were comprehensively searched from inception to September 2024. Eligible studies included systematic reviews and meta-analysis comparing the surgical outcomes of RA-TKA and C-TKA. Two independen researchers performed data extraction and quality assessment. Methodological quality was evaluated using the AMSTAR tool, while the certainty of evidence was graded using GRADE system. The degree of overlap among primary studies included in the systematic reviews/meta-analyses was investigated using the corrected covered area (CCA). RESULTS: A total of 15 systematic reviews/Meta-analyses were included, 5 were rateak as high quality, 1 as moderate quality, and 9 as low quality. A total of 53 pieces of evidence were identified, 11 pieces of evidence were of high quality, 19 were of moderate quality, 16 were of low quality, and 7 were of very low quality. Ten studies assessed the Knee Society score(KSS) and performed a meta-analysis. Among these, seven studies reported that there was no statistically significant difference in postoperative KSS scores between the two surgical methods. Nine studies evaluated the Hospital for Special Surgery(HSS) score, with seven indicating no statistically significant difference in HSS scores following surgery. Twelve studies examined the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score postoperatively, and five found no significant difference between the two surgical approaches. Five studies compared the hip-knee-ankle (HKA) angle deviation between the two groups, all of which demonstrated that the HKA angle deviation in RA-TKA was significantly lower than in C-TKA. Eight studies reported on the range of motion (ROM) of the knee joint after surgery, with six showing no statistically significant difference between the two methods. Finally, nine studies compared the duration of the surgical procedures, all of which concluded that RA-TKA required a longer operative time than C-TKA. CONCLUSION With regard to functional outcomes, no statistically significant difference was observed between RA-TKA and C-TKA. Nevertheless, RA-TKA demonstrates advantages in terms of surgical accuracy, precision, and alignment correction.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Robotic Surgical Procedures/methods* ; Treatment Outcome ; Meta-Analysis as Topic ; Systematic Reviews as Topic

OBJECTIVE

This meta-analysis aimed to evaluate the diagnostic capability of machine learning (ML) models in predicting stone-free status following percutaneous nephrolithotomy (PCNL).

A comprehensive literature search was conducted across MEDLINE, Embase, Scopus, Cochrane, Google Scholar and supplementary databases was undertaken until June 2023. Inclusion criteria were English publications assessing the sensitivity and specificity of ML in predicting post PCNL stone-free status. Studies on non-human subjects or with incomplete data sets were excluded. Quality assessment utilized the Cochrane Risk of Bias Tool. Pooled sensitivity, specificity, and other diagnostic metrics were calculated using Meta-Disc 1.4 software.

Of the 65 initial articles, 5 met the inclusion criteria, representing a total of 1,773 participants. The accuracy of ML models ranged from 44% to 94.8%. The pooled sensitivity and specificity were 0.60 (95% CI [0.57, 0.63]) and 0.87 (95% CI [0.84, 0.89]), respectively. The pooled positive likelihood ratio was 4.69 (95% CI [3.82, 5.77]) and the negative likelihood ratio was 0.45 (95% CI [0.41, 0.48]). The diagnostic odds ratio was 10.93 (95% CI [8.35, 14.33]). The area under the curve (AUC) stood at 0.9372, signifying an excellent diagnostic performance.

Machine learning models demonstrate significant potential in accurately predicting stone-free status post-PCNL. However, the small number of included studies, retrospective designs, and heterogeneity in ML approaches limit generalizability. Standardized definitions, larger multicenter datasets, and prospective validation are required before routine clinical adoption.

OBJECTIVE: To reveal the gap between the evidence of systematic reviews (SRs) and clinical concerns by systematically summarizing the evidence on acupuncture and moxibustion for frozen shoulder and investigating the concerns and needs of clinicians in treatment with acupuncture and moxibustion for this disease. METHODS: The articles of SR and Meta-analysis on acupuncture and moxibustion for frozen shoulder were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase and Cochrane Library, starting from the inception of each database up to December 31st, 2022. Two researchers screened the articles and extracted data independently. Using AMSTAR-2, the methodological quality of the included studies was evaluated. Based on systematic reviews and expert discussion, a questionnaire on clinical concerns of acupuncture and moxibustion for frozen shoulder was developed and distributed to clinicians. The discrepancies between the evidence and clinical concerns were compared from 5 dimensions, including population, interventions, control measures, outcome indicators and review time points. RESULTS: The evidence gaps existed between SRs and clinical concerns. In the existing studies, the needs of personalized treatment were not fully considered in terms of different syndromes/patterns of frozen shoulder and stages of illness, the outcome indicators were not employed properly, the time for outcome measurement was vague, the control groups were set up outside of standardization, and the methodological quality was lower. CONCLUSION It is suggested that future studies should improve the quality of methodology, lay more consideration to different patient groups, optimize outcome indicators and standardize the setting of control groups, so as to better meet the needs of patients and achieve the best match between evidence and clinicians' needs.
Humans ; Acupuncture Therapy ; Bursitis/therapy* ; Evidence Gaps ; Moxibustion ; Systematic Reviews as Topic ; Meta-Analysis as Topic

BACKGROUND: Hospitalization in neonatal intensive care units (NICU) exposes preterm infants to adverse stimuli, including continuous 24-hour lighting. There is currently no standardized NICU layout advised for the best development of preterm neonates. This meta-analysis aimed to assess the impact of cycled light (CL) exposure on clinical outcomes in premature infants admitted to NICU as synthesized in previous studies. MATERIALS AND METHODS: This meta-analysis protocol was developed following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. A search was performed in PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases using the MeSH/key words: ―light exposure‖ AND pre-term AND cycled AND (RCT OR trials OR ―randomized controlled trial). The pooled Mean Difference with corresponding 95% CI was computed for weight gain, duration until start of enteral feeding, and duration of ICU stay using the Mantel–Haenszel random-effect model. RESULTS: Nine studies were included. The pooled mean difference showed that among preterm infants who had cycled light exposure, average daily weight gain (MD=6.24 grams, 95%CI=1.36 to 11.13, p=0.01) was significantly higher than those with continuous light exposure. The average time to start enteral feeding (MD=-3.84 days, 95%CI=-7.56 to -0.13, p=0.04) and average ICU stay (MD=-8.43 days, 95%CI=-12.54 to -4.31, p<0.0001) among neonates who had cycled light exposure were significantly shorter. CONCLUSION Benefits were seen in preterm infants when exposed to cycled light as opposed to continuous light. CL exposed infants showed a daily weight gain that was 6.24 grams higher, on average, and began enteral feeding nearly 4 days sooner. It led to a decrease in the duration of ICU stay by around 8 to 9 days on average. Further trials to determine the impact of cycled light exposure on morbidity and mortality among preterm neonates is recommended.
Human ; Male,Female ; Systematic review ; Meta-analysis ; Infant, Premature ; Intensive care units, Neonatal ; Intensive care, Neonatal ; Light ; Lighting ; Critical care

OBJECTIVE: Attention Deficit Hyperactivity Disorder (ADHD) is a common mental disorder in children. It is unclear how nutrition and dietary components relate to ADHD. Some studies suggest that children with ADHD have lower serum levels of vitamin D than healthy controls. In the current study, the effects of Vitamin D supplementation on ADHD were reviewed and analyzed using available literature. MATERIALS AND METHODS: A meta-analysis and systematic review were performed. Children less than 18 years old diagnosed with ADHD given Vitamin D supplementation or placebo were included. A search was performed in PubMed/MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases from inception to August 2024 using the MeSH keywords: "Vitamin D" AND (ADHD OR Attention Deficit Hyperactivity Disorder) AND (children OR pediatric OR adolescents) AND randomized controlled trial. Standardized Mean Difference (SMD) was used as an effect measure and pooled using random effects meta-analysis. RESULTS: The pooled SMS showed significantly lower ADHD scores (SMD=-0.59, 95%CI=-1.06 to -0.11, p=0.01), lower inattentive scores (SMD=-0.61, 95%CI=-1.00 to -0.23, p=0.002), and lower hyperactivity scores (SMD=-0.64, 95%CI=-1.08 to -0.20, p=0.004) in children given Vitamin D supplementation. The adverse events reported were minor only and did not vary significantly between intervention and control groups. CONCLUSION Vitamin D treatment as an adjuvant to methylphenidate alleviated ADHD symptoms without significant adverse effects, correlating with enhanced vitamin D levels. Given the robust evidence and well-structured randomized controlled trials, we strongly advocate for the integration of vitamin D supplementation with ADHD treatment.
Human ; Male,Female ; Adolescent: 13-18 yrs old ; Child Preschool: 2-5 yrs old ; Child: 6-12 yrs old ; Vitamin D ; meta-analysis ; systematic review

Background: The number of individuals with mild cognitive impairment (MCI), or those people without dementia who are experiencing age-related cognitive decline, has increased in recent years. Conveniently, several interventions to delay cognitive decline exist, where cognitively stimulating activities (CSA) have been receiving too much attention. However, its beneficial effects have not been well established among older people with MCI due to conflicting findings. Objectives: This study aimed to assess and summarize the available evidence on the effects of CSA on the overall cognitive functioning of older people with MCI. Specifically, it sought to answer the PICO question, “In older people with MCI, does engagement in cognitively stimulating activities improve cognitive function?” Methods: A systematic review and meta-analysis of randomized controlled trials examining the effects of CSA on older people with MCI were conducted. Three studies met the inclusion criteria from the 1,328 records from BioMed Central, CINAHL, Cochrane Library, Health Source: Nursing/Academic Edition, MEDLINE, and PubMed databases and 156 articles from WorldCat, DSpace Saint Louis University, and Google Scholar databases and catalogs. Effect size values were inspected using the random-effects model. Data were summarized as standardized mean difference (SMD) with corresponding 95% confidence intervals in the forest plot. Results: This meta-analysis which compared studies that employed similar methodologies, found that CSA has a significant, large effect in improving cognitive functioning among older people with MCI, evidenced by an SMD of 0.798 (95% CI = 0.510-1.085, p = 0.001). While its superiority over other interventions that improve cognitive function was not observed in this study, it was still found that using CSA was helpful in terms of its cost-effectiveness. Also, heterogeneity across studies was non-significant (Cochran’s Q = 0.151, df = 2, p = 0.927, I2 = 0.00%). These results mean that clinical heterogeneity was absent even though a diverse range of CSA was employed. Additionally, methodological diversity was not present since there were no variations in the study design and minimal variability in the risk of bias assessment. Conclusion Overall, it is acknowledged that CSA are effective and practical, inexpensive, non-pharmacologic cognitive training approaches to delay cognitive decline among older people with MCI. However, interpreting this study’s significant, large effect, and non-significant heterogeneity warrants caution.
Cognition ; Cognitive Dysfunction ; Meta-Analysis

PURPOSE

Reflective practice is widely recognized as a fundamental component of nursing education and professional development that had the potential to enhance critical thinking skills. This study intended to evaluate the effect of reflective practice interventions on the critical thinking capability of student nurses.

The quantitative, meta-analysis design was employed. CINAHL, Medline, PubMed, Health Sources and Google Scholar databases weresearched forpublications in English until December 2020.The studies were subjected to quality assessment with the JBI checklist, systematic data extraction and statistical analysis using Comprehensive Meta-analysis version 3.0.

A total of four studies satisfied the inclusion criteria. Reflective practice strategies such as journaling/journal writing and self-regulated learning had effectively enhance critical thinking skills of student nurses (summary effect=0.24; 95% CI [0.13-0.44]; p-value= 0.00004). Sensitivity analysis confirmed the strength of the findings and the publication bias was assessed and found to be minimal.

Reflective practice interventions had positive impact on the improvement of critical thinking capacity of nursing students. With the practical implications for nursing education and professional development, this study had recommended to integrate reflective practice strategies into the curriculum and training programs.

BACKGROUND

Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are rare, chronic autoimmune blistering diseases primarily treated with systemic glucocorticoids. Long-term use of glucocorticoids can result in significant adverse effects, leading to the exploration of steroid-sparing adjuvants. This meta-analysis aimed to evaluate the efficacy and safety of glucocorticoids alone versus in combination with adjuvants for treating PV and PF.

The main objective of this study was to compare the efficacy and safety of oral glucocorticoids alone versus with steroid-sparing adjuvants in treatment of PV and PF.

This research was a systematic review and quantitative meta-analysis of randomized controlled trials (RCTs) that compared systemic glucocorticoids with or without steroid-sparing adjuvants in treating PV and PF. A total of 20 RCTs were included after meeting the inclusion criteria, comprising 1169 patients diagnosed with PV or PF. Primary outcomes were remission rates, while secondary outcomes included relapse rates, disease control, and the occurrence of adverse events.

Studies involving rituximab and cyclophosphamide demonstrated significantly higher remission rates compared to other adjuvants or glucocorticoid monotherapy. Adverse events were common, particularly with high-dose glucocorticoids.

The meta-analysis found that rituximab and cyclophosphamide were superior steroid-sparing adjuvants in the treatment of PV and PF. Other adjuvants, such as azathioprine and mycophenolate mofetil, also showed efficacy but had a higher incidence of adverse events. Further studies were needed to optimize treatment protocols and reduce long-term complications.

BACKGROUND

Long-term administration of conventional acne medications implies the potential risk of increasing microbial resistance, and safety risks. Recent interest has grown in probiotics as a potential treatment and as an adjunct for acne vulgaris.

To conduct a systematic review of randomized controlled trials of oral probiotics in reducing the severity of acne vulgaris compared to placebo or conventional treatments.

PubMed, Cochrane Central Register of Controlled Trials, Embase, WHO ICTRP and ClinicalTrials.gov were searched for relevant studies, and randomized controlled trials of acne vulgaris treatment with probiotic therapy were included. Outcomes include decrease in total lesion count/percent change from baseline, improvement of severity scores, inflammation related indicators, and gene expression. Changes in outcomes were calculated by effect size or pooled odds ratio.

A total of 2 RCTs involving 100 participants were included. Both studies show low risk on the risk bias criteria. The data of 2 RCTs reporting severity scores (AGSS and GAGS) supports that probiotics can improve their scores and thereby their condition. For inflammation-related indicators, only 1 RCT showed that probiotics can improve the IGF1 and FOXO1 gene expression in the skin. Regarding safety, only Eguren et al. reported adverse event. Their RCT showed that the incidence of adverse events was low and no serious adverse events.

In conclusion, the probiotics investigated in both studies may be given as adjuvant treatment for acne vulgaris as they improve the clinical course of patients.

Systematic reviews and meta-analysis combine results and analysis of data from different primary studies (e.g. cross-sectional studies, case-control studies, cohort studies) conducted on similar or related research topics. They are secondary studies that guide clinical decision-making, delivery of care and policy development. This article aims to discuss how to conduct a systematic review and meta-analysis. The steps in conducting a systematic review and meta-analysis include: 1) Identify the purpose including formulating the research question and validating the purpose of the literature scan, 2) Formulate the objectives, 3) Literature search including selection of studies based on population, intervention, comparison and outcome, 4) Retrieval of full text articles, 5) Critical appraisal of articles, 6) Data extraction, 7) Data analysis and 8) Writing the final report. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is a useful guide in conducting and write systematic review and meta-analysis. While ethics approval is not usually required for systematic review and meta-analysis, authors of such study should still observe good practices including avoiding plagiarism, maintaining transparency and ensuring data accuracy.