Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the t...Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.展开更多
BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a n...BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a non-treatable condition.Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life.Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.AIM To evaluate the efficacy of triple probiotic combination on glycaemic,metabolic,oxidative stress,and inflammatory parameters in the diabetic population.METHODS Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified.The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool.Meta-analysis was conducted using RevMan software,and sensitivity analysis was performed using OpenMeta Analyst software.The study protocol was registered in PROSPERO(CRD42-024530999).RESULTS Five good-quality clinical trials were included.Low-to-moderate risk of bias was observed.Data from 300 participants were included(150 participants in both groups).Probiotics supplementation significantly improved glycaemic and insulin parameters(glucose level:-23.86 mg/dL;insulin level:-5.02μIU/mL;HOMA-IR:-1.82 score;QUICKI:+0.02 score;HOMA-B:-16.30 score;P<0.05 for all parameters),reduced oxidative stress and improved antioxidant parameters[TAC:+92.55 mmol/L;glutathione(GSH):+40.55μmol/L;nitric oxide(NO):+6.45μmol/L;malondialdehyde(MDA):-0.48μmol/L;hs-CRP:-2.24 mg/L;P<0.05 for all parameters except GSH],and improved lipid parameters(total cholesterol(TC):-3.43 mg/dL;triglycerides(TG):-4.26 mg/dL;low-density lipoprotein:-4.62 mg/dL;very low-density lipoprotein:-0.83 mg/dL;high-density lipoprotein(HDL):+1.83 mg/dL;TC/HDL ratio:-0.25;P<0.05 for HDL and TC/HDL ratio parameters)compared to the control group.CONCLUSION The combination of L.acidophilus,L.casei,and B.bifidum is effective in diabetic patients with cardio/renal complications.Further well-designed studies are warranted to support the results of current research.展开更多
Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web...Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web of Science,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Technology Journal Database(VIP)from database inception to November 1,2024.Randomized controlled trials(RCTs)that examine the use of EA to improve GI function,reduce pain,and promote ability ofself-care after GI cancer surgery were included.Based on the type of control interventions,separate meta-analyses were conducted for EA vs postoperative nursing(PN)and EA vs sham acupuncture(SA).The primary outcomes were the time to first flatus(TFF)and the time to first defecation(TFD).The secondary outcomes included the time to recovery of bowel sounds(TRBS),the time to tolerance of liquid diet(TTLD),the time to tolerance of semiliquid diet(TTSD),the time to independent walking(TIW),the length of hospitalization(LH),and visual analog scale(VAS)immediate resting pain scores measured on the first,second and third postoperative days(POD 1–3).Results are reported as mean differences(MDs)with 95%confidence intervals(CIs).RevMan 5.3 was used for meta-analysis,StataSE 15.1 was used for sensitivity analyses and Egger’s tests.This study was registered on PROSPERO(CRD42022314754).Results A total of 19 RCTs involving 1902 participants were included,all of which were conducted in China between 2004 and 2023.When EA compared with PN,the meta-analysis showed EA significantly reduce TFF(n=673,MD=-13.14,95%CI=[-18.97 to-7.31],P<0.00001),TFD(n=598,MD=-19.86,95%CI=[-27.83 to-11.89],P<0.00001),TRBS(n=216,MD=-12.44,95%CI=[-15.00 to-9.87],P<0.00001),TTLD(n=268,MD=-18.14,95%CI=[-24.98 to-11.29],P<0.00001),TTSD(n=141,MD=-20.44,95%CI=[-33.84 to-7.04],P=0.003),VAS on POD 1(n=299,MD=-0.52,95%CI=[-0.92 to-0.11],P=0.01),VAS on POD 2(n=256,MD=-0.91,95%CI=[-1.23 to-0.60],P<0.00001),VAS on POD 3(n=203,MD=-0.57,95%CI=[-0.80 to-0.34],P<0.00001),while no significantly decreasing in the LH(n=322,MD=-1.16,95%CI=[-2.56 to 0.24],P=0.10).As EA compared with SA,EA could significantly reduce TFF(n=782,MD=-15.78,95%CI=[-24.96 to-6.60],P=0.0008),TFD(n=782,MD=-20.42,95%CI=[-36.14 to-4.70],P=0.01),LH(n=782,MD=-1.37,95%CI=[-2.69 to-0.05],P=0.04),TIW(n=743,MD=-0.33,95%CI=[-0.62 to-0.04],P=0.03).13 studies reported that EA reduced the incidence of postoperative complications,and 7 studies reported safety assessments of acupuncture-related adverse events,including hematoma,residual needling,sharp pain,pain,soreness or swelling after needle removal,with no serious adverse events.Conclusion EA can significantly promote the recovery of GI function,reduce postoperative pain,enhance ability of self-care in patients undergoing surgery for GI cancers.展开更多
BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy ...BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy and genetic testing have a low sensitivity.Biomarker detection,including thyroglobulin,has reduced accuracy as residual thyroid tissue remains following surgery.Serum/tissue microRNA detection offers a promising alternative to screen for thyroid malignancy.Based on our previous systematic review,miR-146,miR-221 and miR-222 appear most strongly associated with PTC.AIM To perform a systematic review and meta-analysis,evaluating the use of circulating miR-146,miRNA-221 and miR-222 in PTC diagnosis and staging.METHODS A systematic literature search of MEDLINE,Scopus and the EMBASE library was performed.Human participants of any age,sex or geographical distribution were considered.Original studies assessing the diagnostic and prognostic accuracy of circulating serum miRNAs in histologically-confirmed PTC were included.Proportion and regression meta-analyses(logit-transformed)were conducted.PRISMA guidelines were followed throughout the process.RESULTS Among the 1530 studies screened,6 met the inclusion criteria,reporting non-overlapping populations.For the diagnosis of PTC vs benign nodules(BN),the pooled sensitivity of miR-146 was 80.7%(95%CI:65.2%-90.4%),specificity was 66.9%(95%CI:55.5%-76.6%),and false positive rate was 33.1%(95%CI:23.4%-44.5%).Pooled sensitivity,specificity and false positive rate of miR-222 for diagnosis of PTC vs BN was 64.3%(95%CI:50.3%-76.2%),88.8%(95%CI:82.4%-93%)and 11.2%(95%CI:7%-17.6%)respectively.Pooled sensitivity,specificity and false positive rate of miR-221 in this population demonstrated reduced accuracy.Pooled sensitivity and specificity of PTC vs healthy controls for total serum miRNAs were 82%(95%CI:77%-86%)and 84%(95%CI:76%-90%)respectively.The summary area under receiver operating characteristic curve value for the same analysis was 0.89(95%CI:0.86-0.92).CONCLUSION miRNA-146 and miRNA-222 were most sensitive,validating their efficacy in PTC diagnosis.Larger studies are needed for confident population generalisability.Use of two-MRNA types in conjunction needs to be assessed.展开更多
Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are ...Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are currently considered as potential therapies for TMDs.However,high-quality systematic reviews and meta-analyses evaluating their clinical efficacy are lacking.Objective This study aimed to evaluate the clinical efficacy of non-pharmacological interventions for TMDs,focusing on their impact on pain relief,jaw mobility,and functional improvement.Specifically,we aimed to compare the effectiveness of four non-pharmacological interventions,including acupuncture,exercise,occlusal splinting,and laser therapy,for treating TMDs.Methods Comprehensive searches for randomized controlled trials(RCTs)were conducted in PubMed,Web of Science,Scopus,Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,China Biomedical Literature Database(SinoMed),VIP,and Wanfang databases.The primary outcome was visual analog scale(VAS)score.The secondary outcomes included pain-free mouth opening,maximum assisted and unassisted mouth opening,and occurrence of adverse events.We used the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment,Development,and Evaluation approach to assess the risk of bias and the quality of evidence.The meta-analysis was performed using RevMan 5.4 software.Results A total of 22 RCTs involving 717 patients with TMDs were included.Non-pharmacological interventions significantly reduced VAS scores(n=19;mean difference[MD]=–1.86,95%confidence interval[CI]–2.40 to–1.31;Z=6.68;P<0.05)and improved the pain-free mouth opening(n=6;MD=6.92,95%CI 4.91 to 8.94;Z=6.73;P<0.05)and maximum unassisted mouth opening(n=10;MD=4.05,95%CI 2.08 to 6.02;Z=4.04;P<0.05)in patients with TMDs.However,non-pharmacological interventions did not show a significant effect on maximum assisted mouth opening(n=2;MD=0.33,95%CI–4.16 to 4.82;Z=0.15;P=0.88).Only one RCT reported the occurrence of adverse events.Subgroup analysis showed that acupuncture(n=6;MD=–1.52,95%CI–2.86 to–0.18;Z=2.22;P=0.03),exercise(n=4;MD=–1.12,95%CI–1.94 to–0.31,Z=2.70;P<0.05),occlusal splint(n=5;MD=–2.00,95%CI–2.67 to–1.33,Z=5.88;P<0.05),and laser therapy(n=4;MD=–2.81,95%CI–3.89 to–1.73,Z=5.10,P<0.05)were significantly superior to control treatments in reducing VAS scores.In addition,acupuncture(n=2;MD=6.50,95%CI 3.87 to 9.13;Z=4.85;P<0.05),occlusal splint(n=2;MD=8.33,95%CI 4.41 to 12.24;Z=4.17;P<0.05),and laser therapy(n=2;MD=6.09,95%CI 0.86 to 11.32;Z=2.28;P=0.02)significantly improved pain-free mouth opening,whereas exercise(n=2;MD=6.84,95%CI 3.16 to 10.51;Z=3.65;P<0.05)and occlusal splint(n=2;MD=4.93,95%CI 1.66 to 8.19;Z=2.96;P<0.05)increased maximum unassisted mouth opening.Conclusion Nonpharmacological interventions have significant efficacy in relieving pain and enhancing pain-free mouth opening and maximum unassisted mouth opening in patients with TMDs.Specifically,acupuncture,exercise,occlusal splinting,and laser therapy significantly alleviate pain in patients with TMDs.Occlusal splinting showed good effects in improving pain-free mouth opening and maximum unassisted mouth opening,while acupuncture and laser therapy helped improve pain-free mouth opening.Exercise significantly improved maximum unassisted mouth opening.These findings support the application of these treatments in clinical practice and provide evidence to inform future conservative management guidelines for TMDs.展开更多
Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,gly...Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,glycemic control,and psychological well-being.Methods:Nine databases were searched from the inception to October 2024.Effect relationships were assessed using meta-analysis with Stata 17,and the methodological quality and certainty of the evidence were evaluated using standard tools.Results:Twelve studies comprising three study designs(nine randomized controlled,one quasi-exper-imental controlled,and two single-arm clinical trials),were identified.Compared with usual care,TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor(mean difference[MD]=3.86 m/s,95%confidence interval[CI]:0.38 to 7.34,P=0.03),sural sensory(MD=4.15 m/s,95%CI:0.68 to 7.63,P=0.02),median motor(MD=3.84 m/s,95%CI:2.14 to 5.54,P<.001),and median sensory nerves(MD=6.14 m/s,95%CI:4.54 to 7.74,P<.001).TCE practices also reduced glycosylated hemoglobin level(MD=-0.59%,95%CI:-0.91 to-0.27,P<.001)and fasting blood glucose(standardized mean difference[SMD]=-1.08,95%CI:-1.79 to-0.37,P<.001).The overall quality of evidence was very low.Conclusion:The results indicate that TCE therapy improves certain outcomes in patients with DPN.Although the optimal type,intensity,frequency,and duration of TCE interventions are uncertain,these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.展开更多
Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key...Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.展开更多
Cancer presents a major global public health challenge and requires comprehensive treatments such as surgery and chemotherapy.Chinese herbal medicine(CHM)has gained attention as a potential adjunct therapy,but its eff...Cancer presents a major global public health challenge and requires comprehensive treatments such as surgery and chemotherapy.Chinese herbal medicine(CHM)has gained attention as a potential adjunct therapy,but its efficacy remains uncertain.To evaluate this,researchers conducted a search of EMBASE,Web of Science,PubMed,and the Cochrane Library for relevant articles.They included 33 studies with 17 cohorts,assessed the quality using the Newcastle-Ottawa Scale,and performed statistical analyses with Review Manager and STATA software.The results showed that cancer patients receiving CHM had a significantly reduced mortality risk(relative risk=0.79,95%confidence interval=0.72–0.86;P<0.00001).Both the unadjusted hazard ratio(HR)and the adjusted HR indicated a substantially and consistently lowered mortality risk for CHM-treated patients(unadjusted:P=0.00,I2=98.1%,HR=0.57,95%confidence interval=0.52–0.62;adjusted:P<0.00001,I2=98%,HR=0.59,95%confidence interval=0.53–0.66).Subgroup analysis by tumor type showed that CHM reduced mortality risk in patients with respiratory and digestive cancers.In conclusion,CHM treatment,either alone or in combination with chemotherapy,significantly decreases mortality risk in cancer patients.However,these findings need further verification through large-scale,multicenter,high-quality,long-term trials.展开更多
Background: Cancer-related fatigue(CRF) is a significant burden for patients with advanced lung cancer. While exercise is recommended for managing CRF during pre-and active treatment phases, evidence supporting its ef...Background: Cancer-related fatigue(CRF) is a significant burden for patients with advanced lung cancer. While exercise is recommended for managing CRF during pre-and active treatment phases, evidence supporting its efficacy in advanced stage remains limited. This systematic review and meta-analysis aimed to quantify the effects of exercise on CRF and its common complications in patients with advanced lung cancer.Methods: A systematic search of 4 databases(Pub Med, Embase, Cochrane, and Web of Science) was conducted up to July 10, 2024 to identify relevant randomized controlled trials(RCTs). Studies were selected based on predefined eligibility criteria, including adult patients with advanced lung cancer reporting fatigue as an outcome. Study selection followed Preferred Reporting Items for Systematic Reviews and MetaAnalyses(PRISMA) 2020 guidelines, and the risk of bias was assessed using the Cochrane Risk of Bias tool(Ro B 2.0). The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation(GRADE) system. Random-or fixed-effects models were used for meta-analyses based on heterogeneity levels.Results: Eight RCTs involving 749 patients were included. Meta-analysis revealed that exercise significantly improved CRF in patients with advanced lung cancer(standardized mean difference(SMD) =-0.33;95% confidence interval(95%CI):-0.54 to-0.12);p = 0.00;I2= 0.00%).Subgroup analysis showed greater efficacy in patients aged ≤60 years(p = 0.028), those engaging in traditional Chinese exercise(p = 0.003),and interventions lasting fewer than 12 weeks(p = 0.017). Exercise also significantly improved quality of life(SMD = 0.29;95%CI: 0.02-0.55;p = 0.04;I2= 0.00%) and reduced dyspnea(SMD =-0.43;95%CI:-0.71 to-0.16;p = 0.00;I2= 0.00%). No significant effects were observed on sleep quality, anxiety, or depression. The risk of bias across studies was moderate, and the quality of evidence, as evaluated by GRADE, was rated as low due to study limitations. Adverse events were minimal, with only one mild, exercise-related event reported.Conclusion: Exercise significantly alleviates CRF in patients with advanced lung cancer, improves certain complications, and enhances quality of life. The intervention's effectiveness varies by age, type of exercise, and duration. Further high-quality studies are needed to validate these findings.展开更多
Background:considering the significant issue of learning burnout among university students,it is essential to investigate the connection between mindfulness and learning burnout.This systematic review and metaanalysis...Background:considering the significant issue of learning burnout among university students,it is essential to investigate the connection between mindfulness and learning burnout.This systematic review and metaanalysis sought to thoroughly examine the direct and indirect relationships betweenmindfulness and learning burnout.Methods:a comprehensive literature search was conducted in Scopus,Google Scholar,and Web of Science databases until 07 July 2024.A comprehensive literature review analysis of 19 articles was included,which identified three dimensions of learning burnout:emotions,behaviors,and outcomes,determined the indirect and direct relationships between mindfulness and learning burnout,and outlined the indirect relationship between mindfulness and learning burnout.This meta-analysis incorporated data from nine studies,encompassing a total of 5227 university students experiencing learning burnout.Results:the findings revealed a significant negative correlation between mindfulness and learning burnout,with a correlation coefficient of r=-0.396,(98.6%CI[-0.521,-0.272]).Additionally,a notable negative relationship was observed between mindfulness and emotional exhaustion,characterized by a correlation coefficient of r=-0.281,(98.0%CI[-0.438,-0.123]).It also found that mindfulness indirectly influenced learning burnout by other factors(such as self-efficacy,social support,and so on).However,the empirical analysis of the indirect relationship is not supported by sufficient meta-data.Conclusion:this study indicates that there is a significant and negative direct relationship or some indirect correlation between learning burnout and mindfulness,which may affect learning burnout through internal and external factors.These results also highlight the urgent need for a more in-depth exploration of the indirect mechanisms influencing the relationship between mindfulness and learning burnout.展开更多
Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published s...Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.展开更多
BACKGROUND Diabetes mellitus has become one of the major pandemics of the 21st century.In this scenario,nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes ...BACKGROUND Diabetes mellitus has become one of the major pandemics of the 21st century.In this scenario,nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus.Nursing interventions are crucial for managing the disease and preventing complications.AIM To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.METHODS This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables,such as glycated haemoglobin and fasting plasma glucose.RESULTS After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables,a descriptive analysis of the studies with the most significant changes was conducted.Based on this,an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient’s technological skills.CONCLUSION The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.展开更多
A reliable estimation of Candida bloodstream infection prevalence is increasingly important to track changes in Candida species distribution and define burden of ongoing candidemia.A systematic review and meta-analysi...A reliable estimation of Candida bloodstream infection prevalence is increasingly important to track changes in Candida species distribution and define burden of ongoing candidemia.A systematic review and meta-analysis were conducted to estimate candidemia prevalence and identify patterns of Candida species in South-eastern Asia.Systematic electronic-databases literature search was performed on published studies recorded candidemia prevalence in South-Eastern Asia.Using meta-analysis of proportions,the overall pooled prevalences of candidemia by Candida(C.)albicans,C.tropicalis,C.parapsilosis and C.glabrata were calculated as 28.4%(95%CI 24.9-31.8),29.2%(95%CI 24.7-33.7),19.1%(95%CI 14.8-23.4)and 14.0%(95%CI 10.4-17.5),respectively.Based on publication year and country,subgroup analyses were conducted on Candida species to determine heterogeneity source.The findings may not precisely reflect true candidemia prevalence in different countries.Therefore,it highlights continuous need to conduct prevalence studies,assess and monitor growing burden,control effect of potential risk factors and implement regional surveillance programs to prevent further rise.展开更多
BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the ef...BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.展开更多
Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biop...Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biopsy(SNB)before surgery was proposed to detect LNMs in PCa patients.However,its diagnostic performance still remains controversial.This study aimed to investigate the diagnostic performance of ICG for the SNB in PCa.Methods This systematic review and meta-analysis has been reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.The protocol has been registered in the International Prospective Register of Systematic Reviews database,and the register number is CRD42023421911.Four bibliographic databases were searched,i.e.,PubMed,EMBASE,Cochrane Library,and Web of Science,to retrieve articles studying the diagnostic performance of ICG for the SNB in PCa from the inception to Sep 9,2023.We calculated the pooled sensitivity,specificity,likelihood ratios,diagnostic odds ratios and their 95%confidence intervals(CIs).Subgroup analyses and meta-regression analyses were also conducted.Results A total of 17 articles from databases are enrolled in this study.Using lymph node-based data,our results showed that the pooled sensitivity and specificity of applying ICG alone in PCa were 71%(95%CI 52%–85%)and 68%(95%CI 64%–72%),respectively.The pooled sensitivity and specificity of applying ICG-technetium-99m-nanocolloid in PCa were 49%(95%CI 39%–59%)and 69%(95%CI 67%–71%),respectively.展开更多
Background:The use of complementary and alternative medicine(CAM)is common among individuals with underlying chronic illnesses.Objective:This systematic review and meta-analysis investigated the global prevalence and ...Background:The use of complementary and alternative medicine(CAM)is common among individuals with underlying chronic illnesses.Objective:This systematic review and meta-analysis investigated the global prevalence and patterns of CAM use among individuals with chronic kidney disease(CKD).Search strategy:PubMed,Embase,and Cumulative Index to Nursing and Allied Health Literature Plus were searched from inception until 26th February 2024.Inclusion criteria:Original articles reporting the use of at least one type of CAM among individuals aged above 18 years old and at all stages of CKD or undergoing any form of kidney replacement therapy.Data extraction and analysis:Two independent reviewers performed the literature screening.The data were extracted from the included studies by one reviewer and cross-checked by another.Discrepancies were resolved by discussion and consensus among two reviewers.Primary information included prevalence of CAM use,types of CAM used,reasons for CAM use,factors associated with CAM use,and disclosure to healthcare providers.Meta-analyses were performed to determine the pooled prevalence of CAM use and non-disclosure of CAM using a random effect model.Results:Forty-one studies were included in this systematic review and meta-analysis.The pooled prevalence of CAM use was 43%(95%confidence interval:34%,51%),I2=99.46%.The reasons for CAM use included treatment of underlying comorbidities,complications or symptoms,maintenance of general health,and treatment of CKD.Nutritional approaches were the most common CAM modality,with 412different herbal and dietary supplements reported;psychological and physical approaches included massage therapy,relaxation techniques,and mind–body practices;and other complementary health approaches such as homeopathy,traditional Chinese medicine,and Ayurvedic medicine were also frequently reported.Factors associated with CAM use included sociodemographic characteristics such as older age,female gender,or higher income;disease or therapy factors such as not having diabetes,relying on hemodialysis,or poor adherence to medication;and patient or internal factors such as positive attitude towards CAM and perceived safety of CAM.About 66%(61%,72%)of CAM users did not disclose the use of CAM to their healthcare providers.Conclusion:CAM use is prevalent among individuals with CKD,and healthcare providers should communicate openly and effectively to emphasize the rational use of CAM to avoid potential harm.展开更多
A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mel...A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.展开更多
AIM:To evaluate the effectiveness of 532,577,and 810 nm lasers as an initial treatment for non-resolving central serous chorioretinopathy(CSC).METHODS:Following the Cochrane Collaboration Handbook and Preferred Report...AIM:To evaluate the effectiveness of 532,577,and 810 nm lasers as an initial treatment for non-resolving central serous chorioretinopathy(CSC).METHODS:Following the Cochrane Collaboration Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)guidelines,randomized clinical trials(RCTs),non-randomized cohorts,observational studies,and case series(>10 cases)assessing these lasers for non-resolving CSC with≥3mo of follow-up were included.Non-resolving CSC was defined as persistent subretinal fluid(SRF)for>3-6mo.Searches were conducted in PubMed,the Cochrane Library,and Embase(January 17,2025).Two authors independently performed data extraction and assessed the risk of bias.The primary outcome was SRF resolution on optic cherence tomography(OCT)at 3-6mo.Central retinal thickness(CRT)and best-corrected visual acuity(BCVA)were secondary outcomes.A random-effects model was employed to calculate pooled proportions with 95%confidence intervals(CIs),and heterogeneity was assessed using I²and Q statistics.RESULTS:Twenty-four studies(3 RCTs,21 non-RCTs)involving 829 non-resolving CSC eyes(77.6%male,mean age 45.36y)were included.SRF resolution was 59%(95%CI:0.51-0.67;I2=72.6%),showing no significant difference between lasers.Trim-and-fill adjustment raised SRF resolution to 65%(95%CI:0.44-0.81).CRT significantly decreased by 126.32µm(95%CI:95.99-156.65;P<0.0001;I2=95.7%),with the largest reduction noted for the 810 nm laser.BCVA change was 0.10 logMAR(95%CI:-0.03 to 0.22;P=0.13;I2=96.6%),indicating no significant visual improvement.CONCLUSION:This Meta-analysis supports the use of 532,577,and 810 nm subthreshold micropulse lasers as equally effective in resolving SRF in non-resolving CSC.展开更多
Objective To systematically evaluate the overall efficacy of external application of traditional Chinese medicine(EA-TCM)in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-...Objective To systematically evaluate the overall efficacy of external application of traditional Chinese medicine(EA-TCM)in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain(CIBP).Methods We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems.It included four Chinese databases[Chinese Biomedical Literature Database(SinoMed),China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(VIP)],six English databases(Scopus,Embase,Web of Science,PubMed,Cochrane Library,and OpenGrey),and two registration systems(Chinese Clinical Trial Registry and ClinicalTrials.gov).The timeframe for the literature search extended from the inception of each database to December 31,2023.Meta-analysis was performed using RevMan(v5.4.1),and the outcome indicators(pain relief rate,analgesic duration,quality of life,pain intensity,breakthrough pain frequency,and adverse reactions)were graded using GRADE profiler(v3.6).Results According to the established inclusion and exclusion criteria,a total of 43 studies was deemed eligible,involving 3142 participants with CIBP.The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone,the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate[risk ratio(RR)=1.32,95%confidence interval(CI):1.24 to 1.41,P<0.00001],analgesic duration[mean difference(MD)=1.33,95%CI:0.97 to 1.69,P<0.00001],and quality of life(MD=5.66,95%CI:4.88 to 6.44,P<0.00001).Furthermore,the combined therapy significantly reduced pain intensity(MD=-1.00,95%CI:-1.19 to-0.80,P<0.00001),breakthrough pain frequency(MD=-0.43,95%CI:-0.51 to-0.36,P<0.00001),and adverse reactions(RR=0.60,95%CI:0.53 to 0.68,P<0.00001)in CIBP patients.Based on the GRADE assessment,the level of evidence varied from low to moderate.Conclusion EA-TCM combined with the three-step analgesic ladder therapy can effectively alleviate pain symptoms in patients with CIBP and improve their quality of life.Additionally,the EA-TCM can effectively reduce the incidence of adverse reactions associated with threestep analgesic therapy.展开更多
Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and d...Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and develop individualized rehabilitation plans to improve patient prognosis.Methods Databases including the China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBMdisc),China Science and Technology Journal(VIP),WanFang,PubMed,Embase,CINAHL,Web of Science,the Cochrane Library,and Scopus were retrieved to search for literature on the predictors of recovery from dysphagia after stroke.The retrieval period was from January 2013 to December 2023.The quality of studies was assessed using the Newcastle-Ottawa Scale(NOS)and the Prediction model Risk of Bias Assessment Tool(PROBAST).Meta-analysis was performed using Revman5.3 and Stata15.1 software.The review protocol has been registered with PROSPERO(CRD42024605570).Results A total of 1,216 results were obtained,including 599 in English and 617 in Chinese.A total of 34 studies were included,involving 156,309 patients with post-stroke dysphagia,and the rate of dysphagia recovery increased from 13.53%at 1 week to 95%at 6 months after stroke.Meta-analysis results showed that older age[OR=1.06,95%CI(1.04,1.08),P<0.001],lower BMI[OR=1.28,95%CI(1.17,1.40),P<0.001],bilateral stroke[OR=3.10,95%CI(2.04,4.72),P<0.001],higher National Institutes of Health Stroke Scale(NIHSS)score[OR=1.19,95%CI(1.01,1.39),P=0.030],tracheal intubation[OR=5.08,95%CI(1.57,16.39),P=0.007]and aspiration[OR=4.70,95%CI(3.06,7.20),P<0.001]were unfavorable factors for the recovery of swallowing function in patients with post-stroke dysphagia.Conclusions The lack of standardized criteria for rehabilitation assessment of post-stroke dysphagia has resulted in reported recovery rates of swallowing function exhibiting wide variability.Nurses should take targeted preventive measures for patients aged≥70 years,low BMI,bilateral stroke,high NIHSS score,tracheal intubation,and aspiration to promote the recovery of swallowing function in patients with post-stroke dysphagia.展开更多
文摘Background:Isotonic crystalloids are recommended as the first choice for fluid therapy in acute pan-creatitis(AP),with normal saline(NS)and lactate Ringer’s(LR)used most often.Evidence based recom-mendations on the type of fluid are conflicting and generally come from small single-center randomized controlled trials(RCTs).We therefore conducted a systematic review and meta-analysis to compare the effect of balanced solutions(BS)versus NS on patient-centered clinical outcomes in AP.Methods:From four databases searched up to October 2024,we included only RCTs of adult patients with AP that compared the use of BS(including LR,acetate Ringer’s,etc.)with NS.The primary out-come was the disease advances from AP to moderately severe and severe AP(MSAP/SAP).Trial sequential analyses(TSA)were conducted to control for type-I and type-II errors and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)was used to assess the quality of evidence.Results:Six RCTs were identified and included,involving 260 patients treated with BS and 298 patients with NS.Patients who received the BS had less MSAP/SAP[odds ratio(OR)=0.50,95%confidence in-terval(CI):0.29 to 0.85,P=0.01,I^(2)=0%;5 studies,299 patients],reduced the need of ICU admission(OR=0.60,95%CI:0.39 to 0.93,P=0.02,I^(2)=0%;5 studies,507 patients)and shorter length of hospital stay[mean difference(MD)=-0.88,95%CI:-1.48 to-0.28,P=0.004,I^(2)=0%;6 studies,558 patients;confirmed by TSA with high certainty]compared with those who received NS.The evidence for most of the clinical outcomes was rated as moderate to low due to the risk of bias,imprecision and inconsistency.Conclusions:BS,compared with NS,was associated with improved clinical outcomes in patients with AP.However,given the moderate to low quality of evidence for most of the outcomes assessed,further trials are warranted.
文摘BACKGROUND Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality.While various pharmacological and non-pharmacological treatment options are used,diabetes is still a non-treatable condition.Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life.Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.AIM To evaluate the efficacy of triple probiotic combination on glycaemic,metabolic,oxidative stress,and inflammatory parameters in the diabetic population.METHODS Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified.The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool.Meta-analysis was conducted using RevMan software,and sensitivity analysis was performed using OpenMeta Analyst software.The study protocol was registered in PROSPERO(CRD42-024530999).RESULTS Five good-quality clinical trials were included.Low-to-moderate risk of bias was observed.Data from 300 participants were included(150 participants in both groups).Probiotics supplementation significantly improved glycaemic and insulin parameters(glucose level:-23.86 mg/dL;insulin level:-5.02μIU/mL;HOMA-IR:-1.82 score;QUICKI:+0.02 score;HOMA-B:-16.30 score;P<0.05 for all parameters),reduced oxidative stress and improved antioxidant parameters[TAC:+92.55 mmol/L;glutathione(GSH):+40.55μmol/L;nitric oxide(NO):+6.45μmol/L;malondialdehyde(MDA):-0.48μmol/L;hs-CRP:-2.24 mg/L;P<0.05 for all parameters except GSH],and improved lipid parameters(total cholesterol(TC):-3.43 mg/dL;triglycerides(TG):-4.26 mg/dL;low-density lipoprotein:-4.62 mg/dL;very low-density lipoprotein:-0.83 mg/dL;high-density lipoprotein(HDL):+1.83 mg/dL;TC/HDL ratio:-0.25;P<0.05 for HDL and TC/HDL ratio parameters)compared to the control group.CONCLUSION The combination of L.acidophilus,L.casei,and B.bifidum is effective in diabetic patients with cardio/renal complications.Further well-designed studies are warranted to support the results of current research.
基金Supported by the Capital Health Development Research Special Program:2022-4-7016。
文摘Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web of Science,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Technology Journal Database(VIP)from database inception to November 1,2024.Randomized controlled trials(RCTs)that examine the use of EA to improve GI function,reduce pain,and promote ability ofself-care after GI cancer surgery were included.Based on the type of control interventions,separate meta-analyses were conducted for EA vs postoperative nursing(PN)and EA vs sham acupuncture(SA).The primary outcomes were the time to first flatus(TFF)and the time to first defecation(TFD).The secondary outcomes included the time to recovery of bowel sounds(TRBS),the time to tolerance of liquid diet(TTLD),the time to tolerance of semiliquid diet(TTSD),the time to independent walking(TIW),the length of hospitalization(LH),and visual analog scale(VAS)immediate resting pain scores measured on the first,second and third postoperative days(POD 1–3).Results are reported as mean differences(MDs)with 95%confidence intervals(CIs).RevMan 5.3 was used for meta-analysis,StataSE 15.1 was used for sensitivity analyses and Egger’s tests.This study was registered on PROSPERO(CRD42022314754).Results A total of 19 RCTs involving 1902 participants were included,all of which were conducted in China between 2004 and 2023.When EA compared with PN,the meta-analysis showed EA significantly reduce TFF(n=673,MD=-13.14,95%CI=[-18.97 to-7.31],P<0.00001),TFD(n=598,MD=-19.86,95%CI=[-27.83 to-11.89],P<0.00001),TRBS(n=216,MD=-12.44,95%CI=[-15.00 to-9.87],P<0.00001),TTLD(n=268,MD=-18.14,95%CI=[-24.98 to-11.29],P<0.00001),TTSD(n=141,MD=-20.44,95%CI=[-33.84 to-7.04],P=0.003),VAS on POD 1(n=299,MD=-0.52,95%CI=[-0.92 to-0.11],P=0.01),VAS on POD 2(n=256,MD=-0.91,95%CI=[-1.23 to-0.60],P<0.00001),VAS on POD 3(n=203,MD=-0.57,95%CI=[-0.80 to-0.34],P<0.00001),while no significantly decreasing in the LH(n=322,MD=-1.16,95%CI=[-2.56 to 0.24],P=0.10).As EA compared with SA,EA could significantly reduce TFF(n=782,MD=-15.78,95%CI=[-24.96 to-6.60],P=0.0008),TFD(n=782,MD=-20.42,95%CI=[-36.14 to-4.70],P=0.01),LH(n=782,MD=-1.37,95%CI=[-2.69 to-0.05],P=0.04),TIW(n=743,MD=-0.33,95%CI=[-0.62 to-0.04],P=0.03).13 studies reported that EA reduced the incidence of postoperative complications,and 7 studies reported safety assessments of acupuncture-related adverse events,including hematoma,residual needling,sharp pain,pain,soreness or swelling after needle removal,with no serious adverse events.Conclusion EA can significantly promote the recovery of GI function,reduce postoperative pain,enhance ability of self-care in patients undergoing surgery for GI cancers.
文摘BACKGROUND Papillary thyroid cancer(PTC)often recurs following surgical excision,necessitating reliable long-term screening techniques after initial management.Ultrasound scans have a poor predictive value and biopsy and genetic testing have a low sensitivity.Biomarker detection,including thyroglobulin,has reduced accuracy as residual thyroid tissue remains following surgery.Serum/tissue microRNA detection offers a promising alternative to screen for thyroid malignancy.Based on our previous systematic review,miR-146,miR-221 and miR-222 appear most strongly associated with PTC.AIM To perform a systematic review and meta-analysis,evaluating the use of circulating miR-146,miRNA-221 and miR-222 in PTC diagnosis and staging.METHODS A systematic literature search of MEDLINE,Scopus and the EMBASE library was performed.Human participants of any age,sex or geographical distribution were considered.Original studies assessing the diagnostic and prognostic accuracy of circulating serum miRNAs in histologically-confirmed PTC were included.Proportion and regression meta-analyses(logit-transformed)were conducted.PRISMA guidelines were followed throughout the process.RESULTS Among the 1530 studies screened,6 met the inclusion criteria,reporting non-overlapping populations.For the diagnosis of PTC vs benign nodules(BN),the pooled sensitivity of miR-146 was 80.7%(95%CI:65.2%-90.4%),specificity was 66.9%(95%CI:55.5%-76.6%),and false positive rate was 33.1%(95%CI:23.4%-44.5%).Pooled sensitivity,specificity and false positive rate of miR-222 for diagnosis of PTC vs BN was 64.3%(95%CI:50.3%-76.2%),88.8%(95%CI:82.4%-93%)and 11.2%(95%CI:7%-17.6%)respectively.Pooled sensitivity,specificity and false positive rate of miR-221 in this population demonstrated reduced accuracy.Pooled sensitivity and specificity of PTC vs healthy controls for total serum miRNAs were 82%(95%CI:77%-86%)and 84%(95%CI:76%-90%)respectively.The summary area under receiver operating characteristic curve value for the same analysis was 0.89(95%CI:0.86-0.92).CONCLUSION miRNA-146 and miRNA-222 were most sensitive,validating their efficacy in PTC diagnosis.Larger studies are needed for confident population generalisability.Use of two-MRNA types in conjunction needs to be assessed.
基金Supported by Capital's Funds for Health Improvement and Research:CFH2024-2-2235China National Natural Science Foundation:82074179,82374575+3 种基金Beijing Natural Science Foundation:7232270Outstanding Young Talents Program of Capital Medial University:B2207Beijing Hospital Management Center "peak" Talent Training Plan Team:DFL20241001Fifth Batch of National TCM Clinical Outstanding Talents Project。
文摘Background A temporomandibular disorders(TMDs)is a musculoskeletal and neuromuscular condition that affects the temporomandibular joint,masticatory muscles,and associated tissues.Non-pharmacological interventions are currently considered as potential therapies for TMDs.However,high-quality systematic reviews and meta-analyses evaluating their clinical efficacy are lacking.Objective This study aimed to evaluate the clinical efficacy of non-pharmacological interventions for TMDs,focusing on their impact on pain relief,jaw mobility,and functional improvement.Specifically,we aimed to compare the effectiveness of four non-pharmacological interventions,including acupuncture,exercise,occlusal splinting,and laser therapy,for treating TMDs.Methods Comprehensive searches for randomized controlled trials(RCTs)were conducted in PubMed,Web of Science,Scopus,Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,China Biomedical Literature Database(SinoMed),VIP,and Wanfang databases.The primary outcome was visual analog scale(VAS)score.The secondary outcomes included pain-free mouth opening,maximum assisted and unassisted mouth opening,and occurrence of adverse events.We used the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment,Development,and Evaluation approach to assess the risk of bias and the quality of evidence.The meta-analysis was performed using RevMan 5.4 software.Results A total of 22 RCTs involving 717 patients with TMDs were included.Non-pharmacological interventions significantly reduced VAS scores(n=19;mean difference[MD]=–1.86,95%confidence interval[CI]–2.40 to–1.31;Z=6.68;P<0.05)and improved the pain-free mouth opening(n=6;MD=6.92,95%CI 4.91 to 8.94;Z=6.73;P<0.05)and maximum unassisted mouth opening(n=10;MD=4.05,95%CI 2.08 to 6.02;Z=4.04;P<0.05)in patients with TMDs.However,non-pharmacological interventions did not show a significant effect on maximum assisted mouth opening(n=2;MD=0.33,95%CI–4.16 to 4.82;Z=0.15;P=0.88).Only one RCT reported the occurrence of adverse events.Subgroup analysis showed that acupuncture(n=6;MD=–1.52,95%CI–2.86 to–0.18;Z=2.22;P=0.03),exercise(n=4;MD=–1.12,95%CI–1.94 to–0.31,Z=2.70;P<0.05),occlusal splint(n=5;MD=–2.00,95%CI–2.67 to–1.33,Z=5.88;P<0.05),and laser therapy(n=4;MD=–2.81,95%CI–3.89 to–1.73,Z=5.10,P<0.05)were significantly superior to control treatments in reducing VAS scores.In addition,acupuncture(n=2;MD=6.50,95%CI 3.87 to 9.13;Z=4.85;P<0.05),occlusal splint(n=2;MD=8.33,95%CI 4.41 to 12.24;Z=4.17;P<0.05),and laser therapy(n=2;MD=6.09,95%CI 0.86 to 11.32;Z=2.28;P=0.02)significantly improved pain-free mouth opening,whereas exercise(n=2;MD=6.84,95%CI 3.16 to 10.51;Z=3.65;P<0.05)and occlusal splint(n=2;MD=4.93,95%CI 1.66 to 8.19;Z=2.96;P<0.05)increased maximum unassisted mouth opening.Conclusion Nonpharmacological interventions have significant efficacy in relieving pain and enhancing pain-free mouth opening and maximum unassisted mouth opening in patients with TMDs.Specifically,acupuncture,exercise,occlusal splinting,and laser therapy significantly alleviate pain in patients with TMDs.Occlusal splinting showed good effects in improving pain-free mouth opening and maximum unassisted mouth opening,while acupuncture and laser therapy helped improve pain-free mouth opening.Exercise significantly improved maximum unassisted mouth opening.These findings support the application of these treatments in clinical practice and provide evidence to inform future conservative management guidelines for TMDs.
基金funded by the Seed Funding of the Beijing University of Chinese Medicine(90011451310034).
文摘Objective:To evaluate the efficacy and safety of traditional Chinese exercises(TCE)in patients with diabetic peripheral neuropathy(DPN)and to recommend best practices for using TCE to improve neurological function,glycemic control,and psychological well-being.Methods:Nine databases were searched from the inception to October 2024.Effect relationships were assessed using meta-analysis with Stata 17,and the methodological quality and certainty of the evidence were evaluated using standard tools.Results:Twelve studies comprising three study designs(nine randomized controlled,one quasi-exper-imental controlled,and two single-arm clinical trials),were identified.Compared with usual care,TCE improved various indicators and enhanced the nerve conduction velocities of the peroneal motor(mean difference[MD]=3.86 m/s,95%confidence interval[CI]:0.38 to 7.34,P=0.03),sural sensory(MD=4.15 m/s,95%CI:0.68 to 7.63,P=0.02),median motor(MD=3.84 m/s,95%CI:2.14 to 5.54,P<.001),and median sensory nerves(MD=6.14 m/s,95%CI:4.54 to 7.74,P<.001).TCE practices also reduced glycosylated hemoglobin level(MD=-0.59%,95%CI:-0.91 to-0.27,P<.001)and fasting blood glucose(standardized mean difference[SMD]=-1.08,95%CI:-1.79 to-0.37,P<.001).The overall quality of evidence was very low.Conclusion:The results indicate that TCE therapy improves certain outcomes in patients with DPN.Although the optimal type,intensity,frequency,and duration of TCE interventions are uncertain,these preliminary findings suggest that TCE should be further studied as a potentially affordable and effective treatment for DPN.
文摘Objectives This study aimed to determine the current prevalence of nurse retention in Sub-Saharan Africa(SSA),evaluate the strategies and interventions in SSA countries used to retain their nurses,and identify the key challenges impeding nurse retention.Methods A systematic review and meta-analysis were conducted.An electronic search was performed in August 2024 across multiple databases,including PubMed,Ovid Medline,Embase,CINAHL,Scopus,and grey literature sources.The studies were screened using Covidence,and quality assessments were conducted using the Mixed Methods Appraisal Tool.Results A total of 31 articles were included in the review.Meta-analysis revealed that the pooled nurses’retention rate in SSA was 53%(95%CI:38%–67%;I2=97%),while the pooled intention to stay(ITS)rate at work was 57%(95%CI:43%–71%;I2=99%).Subgroup analysis by region showed that the ITS rate was highest in East Africa(65%),followed by West Africa(63%),and lowest in Southern Africa(35%).Effective retention strategies included financial and non-financial incentives,increased production and training of nurses,steering students to shortage specialties,adequate rural housing,facility level improvements,availability of career and professional progression opportunities,nurses’recognition and involvement,employment terms,transparency and predictable management of human resources,supportive work environments,leadership,religious factors,and stakeholders’collaborations.Key challenges to nurses’retention include inadequate healthcare funding,governance issues,poor remuneration and working conditions,political interference,high unemployment rates,ineffective mobility management,unregulated international migration,and active recruitment by wealthier nations.Conclusions Nurse retention in SSA remains critically low.Interventions should be formulated for the above-mentioned effective improvement strategies to address these systemic challenges in order to retain nurses in SSA.
基金supported by the National Natural Science Foundation of China(No.82060519,81760519,81560429)the Yunnan Provincial Department of Science and Technology-Yunnan University of Chinese Medicine Applied Basic Research Joint Special Key Project(2019FF002(-011))+3 种基金Yunnan Province 10,000 people plan young top-notch talents(YNWR-QNBJ-2018-212)Yunnan Provincial Department of Science and Technology-Yunnan University of Chinese Medicine Applied Basic Research Joint Special Project(202301AZ070001-062)State Administration of Traditional Chinese Medicine High-level Chinese Medicine Key Discipline Construction Project“Dai Medicine”Yunnan Science and Technology Talent and Platform Program(202105AG070012).
文摘Cancer presents a major global public health challenge and requires comprehensive treatments such as surgery and chemotherapy.Chinese herbal medicine(CHM)has gained attention as a potential adjunct therapy,but its efficacy remains uncertain.To evaluate this,researchers conducted a search of EMBASE,Web of Science,PubMed,and the Cochrane Library for relevant articles.They included 33 studies with 17 cohorts,assessed the quality using the Newcastle-Ottawa Scale,and performed statistical analyses with Review Manager and STATA software.The results showed that cancer patients receiving CHM had a significantly reduced mortality risk(relative risk=0.79,95%confidence interval=0.72–0.86;P<0.00001).Both the unadjusted hazard ratio(HR)and the adjusted HR indicated a substantially and consistently lowered mortality risk for CHM-treated patients(unadjusted:P=0.00,I2=98.1%,HR=0.57,95%confidence interval=0.52–0.62;adjusted:P<0.00001,I2=98%,HR=0.59,95%confidence interval=0.53–0.66).Subgroup analysis by tumor type showed that CHM reduced mortality risk in patients with respiratory and digestive cancers.In conclusion,CHM treatment,either alone or in combination with chemotherapy,significantly decreases mortality risk in cancer patients.However,these findings need further verification through large-scale,multicenter,high-quality,long-term trials.
基金supported by funding from the National Key Research and Development Program of China(Research Project of Modernization on TCM,Grant number:2018YFC1707406)。
文摘Background: Cancer-related fatigue(CRF) is a significant burden for patients with advanced lung cancer. While exercise is recommended for managing CRF during pre-and active treatment phases, evidence supporting its efficacy in advanced stage remains limited. This systematic review and meta-analysis aimed to quantify the effects of exercise on CRF and its common complications in patients with advanced lung cancer.Methods: A systematic search of 4 databases(Pub Med, Embase, Cochrane, and Web of Science) was conducted up to July 10, 2024 to identify relevant randomized controlled trials(RCTs). Studies were selected based on predefined eligibility criteria, including adult patients with advanced lung cancer reporting fatigue as an outcome. Study selection followed Preferred Reporting Items for Systematic Reviews and MetaAnalyses(PRISMA) 2020 guidelines, and the risk of bias was assessed using the Cochrane Risk of Bias tool(Ro B 2.0). The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation(GRADE) system. Random-or fixed-effects models were used for meta-analyses based on heterogeneity levels.Results: Eight RCTs involving 749 patients were included. Meta-analysis revealed that exercise significantly improved CRF in patients with advanced lung cancer(standardized mean difference(SMD) =-0.33;95% confidence interval(95%CI):-0.54 to-0.12);p = 0.00;I2= 0.00%).Subgroup analysis showed greater efficacy in patients aged ≤60 years(p = 0.028), those engaging in traditional Chinese exercise(p = 0.003),and interventions lasting fewer than 12 weeks(p = 0.017). Exercise also significantly improved quality of life(SMD = 0.29;95%CI: 0.02-0.55;p = 0.04;I2= 0.00%) and reduced dyspnea(SMD =-0.43;95%CI:-0.71 to-0.16;p = 0.00;I2= 0.00%). No significant effects were observed on sleep quality, anxiety, or depression. The risk of bias across studies was moderate, and the quality of evidence, as evaluated by GRADE, was rated as low due to study limitations. Adverse events were minimal, with only one mild, exercise-related event reported.Conclusion: Exercise significantly alleviates CRF in patients with advanced lung cancer, improves certain complications, and enhances quality of life. The intervention's effectiveness varies by age, type of exercise, and duration. Further high-quality studies are needed to validate these findings.
文摘Background:considering the significant issue of learning burnout among university students,it is essential to investigate the connection between mindfulness and learning burnout.This systematic review and metaanalysis sought to thoroughly examine the direct and indirect relationships betweenmindfulness and learning burnout.Methods:a comprehensive literature search was conducted in Scopus,Google Scholar,and Web of Science databases until 07 July 2024.A comprehensive literature review analysis of 19 articles was included,which identified three dimensions of learning burnout:emotions,behaviors,and outcomes,determined the indirect and direct relationships between mindfulness and learning burnout,and outlined the indirect relationship between mindfulness and learning burnout.This meta-analysis incorporated data from nine studies,encompassing a total of 5227 university students experiencing learning burnout.Results:the findings revealed a significant negative correlation between mindfulness and learning burnout,with a correlation coefficient of r=-0.396,(98.6%CI[-0.521,-0.272]).Additionally,a notable negative relationship was observed between mindfulness and emotional exhaustion,characterized by a correlation coefficient of r=-0.281,(98.0%CI[-0.438,-0.123]).It also found that mindfulness indirectly influenced learning burnout by other factors(such as self-efficacy,social support,and so on).However,the empirical analysis of the indirect relationship is not supported by sufficient meta-data.Conclusion:this study indicates that there is a significant and negative direct relationship or some indirect correlation between learning burnout and mindfulness,which may affect learning burnout through internal and external factors.These results also highlight the urgent need for a more in-depth exploration of the indirect mechanisms influencing the relationship between mindfulness and learning burnout.
基金supported by the National Natural Science Foundation of China(No.82474644)the National Key R&D Foundation of China(No.2017YFC1703600)+1 种基金the Shenzhen“Sanming Project”(No.202101007)the Shenzhen Science and Technology Program(No.JCYJ2022081810080300)。
文摘Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.
文摘BACKGROUND Diabetes mellitus has become one of the major pandemics of the 21st century.In this scenario,nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus.Nursing interventions are crucial for managing the disease and preventing complications.AIM To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.METHODS This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables,such as glycated haemoglobin and fasting plasma glucose.RESULTS After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables,a descriptive analysis of the studies with the most significant changes was conducted.Based on this,an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient’s technological skills.CONCLUSION The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.
文摘A reliable estimation of Candida bloodstream infection prevalence is increasingly important to track changes in Candida species distribution and define burden of ongoing candidemia.A systematic review and meta-analysis were conducted to estimate candidemia prevalence and identify patterns of Candida species in South-eastern Asia.Systematic electronic-databases literature search was performed on published studies recorded candidemia prevalence in South-Eastern Asia.Using meta-analysis of proportions,the overall pooled prevalences of candidemia by Candida(C.)albicans,C.tropicalis,C.parapsilosis and C.glabrata were calculated as 28.4%(95%CI 24.9-31.8),29.2%(95%CI 24.7-33.7),19.1%(95%CI 14.8-23.4)and 14.0%(95%CI 10.4-17.5),respectively.Based on publication year and country,subgroup analyses were conducted on Candida species to determine heterogeneity source.The findings may not precisely reflect true candidemia prevalence in different countries.Therefore,it highlights continuous need to conduct prevalence studies,assess and monitor growing burden,control effect of potential risk factors and implement regional surveillance programs to prevent further rise.
文摘BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.
文摘Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biopsy(SNB)before surgery was proposed to detect LNMs in PCa patients.However,its diagnostic performance still remains controversial.This study aimed to investigate the diagnostic performance of ICG for the SNB in PCa.Methods This systematic review and meta-analysis has been reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.The protocol has been registered in the International Prospective Register of Systematic Reviews database,and the register number is CRD42023421911.Four bibliographic databases were searched,i.e.,PubMed,EMBASE,Cochrane Library,and Web of Science,to retrieve articles studying the diagnostic performance of ICG for the SNB in PCa from the inception to Sep 9,2023.We calculated the pooled sensitivity,specificity,likelihood ratios,diagnostic odds ratios and their 95%confidence intervals(CIs).Subgroup analyses and meta-regression analyses were also conducted.Results A total of 17 articles from databases are enrolled in this study.Using lymph node-based data,our results showed that the pooled sensitivity and specificity of applying ICG alone in PCa were 71%(95%CI 52%–85%)and 68%(95%CI 64%–72%),respectively.The pooled sensitivity and specificity of applying ICG-technetium-99m-nanocolloid in PCa were 49%(95%CI 39%–59%)and 69%(95%CI 67%–71%),respectively.
文摘Background:The use of complementary and alternative medicine(CAM)is common among individuals with underlying chronic illnesses.Objective:This systematic review and meta-analysis investigated the global prevalence and patterns of CAM use among individuals with chronic kidney disease(CKD).Search strategy:PubMed,Embase,and Cumulative Index to Nursing and Allied Health Literature Plus were searched from inception until 26th February 2024.Inclusion criteria:Original articles reporting the use of at least one type of CAM among individuals aged above 18 years old and at all stages of CKD or undergoing any form of kidney replacement therapy.Data extraction and analysis:Two independent reviewers performed the literature screening.The data were extracted from the included studies by one reviewer and cross-checked by another.Discrepancies were resolved by discussion and consensus among two reviewers.Primary information included prevalence of CAM use,types of CAM used,reasons for CAM use,factors associated with CAM use,and disclosure to healthcare providers.Meta-analyses were performed to determine the pooled prevalence of CAM use and non-disclosure of CAM using a random effect model.Results:Forty-one studies were included in this systematic review and meta-analysis.The pooled prevalence of CAM use was 43%(95%confidence interval:34%,51%),I2=99.46%.The reasons for CAM use included treatment of underlying comorbidities,complications or symptoms,maintenance of general health,and treatment of CKD.Nutritional approaches were the most common CAM modality,with 412different herbal and dietary supplements reported;psychological and physical approaches included massage therapy,relaxation techniques,and mind–body practices;and other complementary health approaches such as homeopathy,traditional Chinese medicine,and Ayurvedic medicine were also frequently reported.Factors associated with CAM use included sociodemographic characteristics such as older age,female gender,or higher income;disease or therapy factors such as not having diabetes,relying on hemodialysis,or poor adherence to medication;and patient or internal factors such as positive attitude towards CAM and perceived safety of CAM.About 66%(61%,72%)of CAM users did not disclose the use of CAM to their healthcare providers.Conclusion:CAM use is prevalent among individuals with CKD,and healthcare providers should communicate openly and effectively to emphasize the rational use of CAM to avoid potential harm.
基金Jiangsu College of Nursing 2023 Special Fund for Research and Development of Medical-Educational Integration。
文摘A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.
文摘AIM:To evaluate the effectiveness of 532,577,and 810 nm lasers as an initial treatment for non-resolving central serous chorioretinopathy(CSC).METHODS:Following the Cochrane Collaboration Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analysis(PRISMA)guidelines,randomized clinical trials(RCTs),non-randomized cohorts,observational studies,and case series(>10 cases)assessing these lasers for non-resolving CSC with≥3mo of follow-up were included.Non-resolving CSC was defined as persistent subretinal fluid(SRF)for>3-6mo.Searches were conducted in PubMed,the Cochrane Library,and Embase(January 17,2025).Two authors independently performed data extraction and assessed the risk of bias.The primary outcome was SRF resolution on optic cherence tomography(OCT)at 3-6mo.Central retinal thickness(CRT)and best-corrected visual acuity(BCVA)were secondary outcomes.A random-effects model was employed to calculate pooled proportions with 95%confidence intervals(CIs),and heterogeneity was assessed using I²and Q statistics.RESULTS:Twenty-four studies(3 RCTs,21 non-RCTs)involving 829 non-resolving CSC eyes(77.6%male,mean age 45.36y)were included.SRF resolution was 59%(95%CI:0.51-0.67;I2=72.6%),showing no significant difference between lasers.Trim-and-fill adjustment raised SRF resolution to 65%(95%CI:0.44-0.81).CRT significantly decreased by 126.32µm(95%CI:95.99-156.65;P<0.0001;I2=95.7%),with the largest reduction noted for the 810 nm laser.BCVA change was 0.10 logMAR(95%CI:-0.03 to 0.22;P=0.13;I2=96.6%),indicating no significant visual improvement.CONCLUSION:This Meta-analysis supports the use of 532,577,and 810 nm subthreshold micropulse lasers as equally effective in resolving SRF in non-resolving CSC.
基金Provincial Key Research and Development Project of Hunan(2018SK2127)Hunan Province Traditional Chinese Medicine Research and Development Project(201946).
文摘Objective To systematically evaluate the overall efficacy of external application of traditional Chinese medicine(EA-TCM)in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain(CIBP).Methods We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems.It included four Chinese databases[Chinese Biomedical Literature Database(SinoMed),China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(VIP)],six English databases(Scopus,Embase,Web of Science,PubMed,Cochrane Library,and OpenGrey),and two registration systems(Chinese Clinical Trial Registry and ClinicalTrials.gov).The timeframe for the literature search extended from the inception of each database to December 31,2023.Meta-analysis was performed using RevMan(v5.4.1),and the outcome indicators(pain relief rate,analgesic duration,quality of life,pain intensity,breakthrough pain frequency,and adverse reactions)were graded using GRADE profiler(v3.6).Results According to the established inclusion and exclusion criteria,a total of 43 studies was deemed eligible,involving 3142 participants with CIBP.The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone,the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate[risk ratio(RR)=1.32,95%confidence interval(CI):1.24 to 1.41,P<0.00001],analgesic duration[mean difference(MD)=1.33,95%CI:0.97 to 1.69,P<0.00001],and quality of life(MD=5.66,95%CI:4.88 to 6.44,P<0.00001).Furthermore,the combined therapy significantly reduced pain intensity(MD=-1.00,95%CI:-1.19 to-0.80,P<0.00001),breakthrough pain frequency(MD=-0.43,95%CI:-0.51 to-0.36,P<0.00001),and adverse reactions(RR=0.60,95%CI:0.53 to 0.68,P<0.00001)in CIBP patients.Based on the GRADE assessment,the level of evidence varied from low to moderate.Conclusion EA-TCM combined with the three-step analgesic ladder therapy can effectively alleviate pain symptoms in patients with CIBP and improve their quality of life.Additionally,the EA-TCM can effectively reduce the incidence of adverse reactions associated with threestep analgesic therapy.
文摘Objective This systematic review aimed to identify the predictors of recovery from dysphagia after stroke in the last ten years,thereby providing an evidence-based basis for nurses to identify high-risk patients and develop individualized rehabilitation plans to improve patient prognosis.Methods Databases including the China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBMdisc),China Science and Technology Journal(VIP),WanFang,PubMed,Embase,CINAHL,Web of Science,the Cochrane Library,and Scopus were retrieved to search for literature on the predictors of recovery from dysphagia after stroke.The retrieval period was from January 2013 to December 2023.The quality of studies was assessed using the Newcastle-Ottawa Scale(NOS)and the Prediction model Risk of Bias Assessment Tool(PROBAST).Meta-analysis was performed using Revman5.3 and Stata15.1 software.The review protocol has been registered with PROSPERO(CRD42024605570).Results A total of 1,216 results were obtained,including 599 in English and 617 in Chinese.A total of 34 studies were included,involving 156,309 patients with post-stroke dysphagia,and the rate of dysphagia recovery increased from 13.53%at 1 week to 95%at 6 months after stroke.Meta-analysis results showed that older age[OR=1.06,95%CI(1.04,1.08),P<0.001],lower BMI[OR=1.28,95%CI(1.17,1.40),P<0.001],bilateral stroke[OR=3.10,95%CI(2.04,4.72),P<0.001],higher National Institutes of Health Stroke Scale(NIHSS)score[OR=1.19,95%CI(1.01,1.39),P=0.030],tracheal intubation[OR=5.08,95%CI(1.57,16.39),P=0.007]and aspiration[OR=4.70,95%CI(3.06,7.20),P<0.001]were unfavorable factors for the recovery of swallowing function in patients with post-stroke dysphagia.Conclusions The lack of standardized criteria for rehabilitation assessment of post-stroke dysphagia has resulted in reported recovery rates of swallowing function exhibiting wide variability.Nurses should take targeted preventive measures for patients aged≥70 years,low BMI,bilateral stroke,high NIHSS score,tracheal intubation,and aspiration to promote the recovery of swallowing function in patients with post-stroke dysphagia.
