The prevalence and risk of anxiety and depression in polycystic ovary syndrome: an overview of systematic reviews with meta-analysis.

PURPOSE: To summarize the pooled prevalence rates of anxiety and depression in women with polycystic ovary syndrome. METHODS: An overview of systematic reviews with meta-analysis was conducted. The CINAHL, Embase, PsycINFO, and PubMed databases were searched up to April 22, 2024. The methodological quality of systematic reviews was assessed using AMSTAR 2. The degree of overlap between reviews was analyzed by calculating the corrected covered area. RESULTS: Ten systematic reviews were selected. Regarding anxiety disorders, the pooled prevalence of panic disorder, social phobia, and anxiety disorders without specifying the type of disorder were 4%, 5%, and 16.9%, respectively. This prevalence was higher in depressive disorders, reaching 34.8%. Anxiety symptoms were very prevalent in women with PCOS, although the prevalence varied depending on the self-reported questionnaire used: the Hamilton Anxiety Scale 69.4%, the Hospital Anxiety and Depression Scale 41.5%, and the Self-rating Anxiety Scale 32.4%. Additionally, the highest prevalence of depression symptoms was associated with the Beck Depression Inventory 46.0%, followed by the Self-rating Depression Scale 39.2%, and the Hospital Anxiety and Depression Scale, which ranged from 31% to 33.8%. CONCLUSIONS: Meta-analyses found mainly anxiety and depression symptoms and disorders are prevalent in women with PCOS. Meta-analyses also showed women with PCOS had a higher risk of having anxiety disorders, and depression symptoms than women without PCOS. HIGHLIGHTS: • Anxiety symptoms were prevalent, although the prevalence varied depending on the self-reported questionnaire. • The highest prevalence of depression symptoms was associated with the Beck Depression Inventory (46.0%). • The pooled prevalence of anxiety disorders without specifying the type of disorder was 16.9%.

Estimates for diagnostic accuracy of rapid antigen tests for SARS-CoV-2 in systematic reviews are consistently similar despite poor methodological rigor: a methodological overview.

OBJECTIVES: To evaluate the design, conduct, and analysis of systematic reviews on the diagnostic accuracy of rapid antigen tests for SARS-CoV-2 during the COVID-19 pandemic. STUDY DESIGN AND SETTING: We did a methodological overview of systematic reviews on diagnostic test accuracy, exploring methodological rigor, risk of bias and potential factors of between-review variability. RESULTS: Of the 31 included reviews, 30 provided summary statistics for sensitivity and 29 for specificity. Summary sensitivities ranged from 56.2% to 91.1%, with a median of 71.5% (IQR 68.3%-76.6%) and a mean of 72.7% with a 7.2 SD. Reported summary specificity estimates were consistently high: median 99.5% (IQR 99%-99.9%) and a mean of 99.3% with a 0.9 SD. We found methodological shortcomings in the systematic reviews, with a majority showing critically low confidence in quality and a high risk of bias. CONCLUSION: Despite significant methodological flaws in the reviews, the diagnostic accuracy estimates for rapid antigen tests were characterized by a strong central tendency, highlighting the importance of large sample sizes and broad participant representation. This study suggests the need for further research in diagnostic test accuracy assessments of rigor and risk of bias in systematic reviews.

World Health Organization repository of systematic reviews on interventions in environment, climate change and health: a new resource for decision makers, intervention implementers, and researchers.

To facilitate the use of the mounting evidence on how human health is inextricably linked to the health of the planet and the urgent need for measures against the escalating triple planetary crisis, the WHO has developed a repository of systematic reviews on interventions in the area of environment, climate change and health (ECH). This commentary introduces the repository, describes its rationale and development, and points to potential future evolutions. The repository aims to provide a user-friendly tool for quickly finding systematic reviews and meta-analyses on specific ECH topics. The spreadsheet includes details on each systematic review, such as population, intervention type, control group, outcomes, and location, among other information. This supports effective assessment of the available evidence, potentially informing policy decisions across various sectors. The repository is a resource for anyone interested in the interlinkages between health and environment and is also targeted at decision makers, intervention implementers and researchers in order to identify priority issues and support evidence-based action. Furthermore, it can be used to identify areas in need of greater research. Additionally, systematic reviews of intervention effectiveness are often used for setting general guidelines and standards, for choosing the most promising intervention in a certain situation and for calculating the disease burden attributable to a specific environmental risk.

Two cases of pancreatic tuberculosis in immunocompetent individuals presenting as diabetes mellitus: An overview of clinical features, diagnosis and management.

Mycobacterium tuberculosis (TB) disease is a major global health problem affecting 10.6 million people worldwide, and India alone contributes 28% to this burden. Pancreatic TB is considered an extremely rare entity which closely mimics pancreatic carcinoma. However, while 87% of the total globally notified TB cases are from 30 high-burden countries mostly from Asia, about 45% of pancreatic TB cases are from developed countries. This suggests that the identified cases of pancreatic TB in developing counties are just the tip of iceberg, and many cases either remain undetected or wrongly diagnosed. The majority of the patients with pancreatic TB undergo extensive evaluation and frequently undergo major abdominal surgeries since pancreatic carcinoma is often considered as the most probable diagnosis before TB. Here, 2 cases of pancreatic TB managed separately at two different centers are described. Both cases presented with significant unintentional weight loss and poor glycemic control which is an unusual presentation for pancreatic TB. Imaging showed pancreatic mass lesions, and initially pancreatic carcinoma was considered by the treating physicians. Chromogranin A in both patients and tumor markers done in one of the patients were negative. Both the patients underwent Ga-68 DOTANOC PET/CT scan, and one of the patients even showed multiple DOTANOC avid lesions. Owing to contradictory biochemical and imaging findings, biopsy of the pancreatic mass was done which clinched the diagnosis of pancreatic TB. On starting standard anti-tubercular therapy (ATT), both patients showed clinical and radiological recovery with a significant regain of glycemic control. The clinical features, appropriate investigation including imaging and tissue biopsy, and treatment options are described in the article for better understanding of the disease. This may guide clinicians in early detection of pancreatic TB with least invasive diagnostic procedures.

The Multifaceted Non-Genetic Risk Factors for Primary Open-Angle Glaucoma - An Overview of Systematic Reviews.

TOPIC: A synthesis of the current knowledge on risk factors for primary open-angle glaucoma (POAG). METHOD: We conducted a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library to identify relevant systematic reviews (SR) published in English after 2012. The inclusion criteria focused on SRs investigating risk factors for POAG. We registered the study prospectively in the PROSPERO database (CRD42022351372) and used Covidence and the Risk Of Bias In Systematic reviews (ROBIS) tool to manage article selection and assess the risk of bias in the included SRs. Data was extracted independently by two authors. RESULTS: After removing duplicate SRs, we assessed 2,542 SRs. Of these, 2,396 were determined to be irrelevant, leaving 138 for a full text review. Following this, 78 were excluded with reasons, resulting in 57 SRs. Of these, 30 had a low risk of bias. In our bias assessment, SRs categorized as high risk of bias were characterized by 1) lack of sufficient detail in the bias assessment of the SR and 2) insufficient information or missing calculations of heterogeneity among the included studies. In our study, we identified 22 risk factors associated with POAG. The SRs covered a wide range of risk factors for POAG. Among these, the strongest associations with glaucoma, based on effect size, were observed in two SRs related to obstructive sleep apnea (OSA), with a pooled odds ratio (OR) of 3.66 (95% CI: 1.70-7.90) and an adjusted OR of 2.46 (95% CI: 1.32-4.59). Similarly, two SRs investigating Helicobacter pylori (H. pylori) infections showed significant associations, with pooled ORs of 2.08 (95% CI: 1.48-2.93) and 2.08 (95% CI: 1.42-3.04), respectively. CONCLUSION: This article summarizes the current knowledge on risk factors for POAG from published SRs. Our findings highlight the complexity of the disease and the nature of the factors that may affect various populations. Among the reported associations with low risk of bias, we found the highest effect estimates for OSA and H. pylori infections in relation to POAG. Our review helps advance understanding, guide future research and inform strategies for the prevention and treatment of POAG.

Usability Assessment Methods for Mobile Apps for Physical Rehabilitation: Umbrella Review.

BACKGROUND: Usability has been touted as one determiner of success of mobile health (mHealth) interventions. Multiple systematic reviews of usability assessment approaches for different mHealth solutions for physical rehabilitation are available. However, there is a lack of synthesis in this portion of the literature, which results in clinicians and developers devoting a significant amount of time and effort in analyzing and summarizing a large body of systematic reviews. OBJECTIVE: This study aims to summarize systematic reviews examining usability assessment instruments, or measurements tools, in mHealth interventions including physical rehabilitation. METHODS: An umbrella review was conducted according to a published registered protocol. A topic-based search of PubMed, Cochrane, IEEE Xplore, Epistemonikos, Web of Science, and CINAHL Complete was conducted from January 2015 to April 2023 for systematic reviews investigating usability assessment instruments in mHealth interventions including physical exercise rehabilitation. Eligibility screening included date, language, participant, and article type. Data extraction and assessment of the methodological quality (AMSTAR 2 [A Measurement Tool to Assess Systematic Reviews 2]) was completed and tabulated for synthesis. RESULTS: A total of 12 systematic reviews were included, of which 3 (25%) did not refer to any theoretical usability framework and the remaining (n=9, 75%) most commonly referenced the ISO framework. The sample referenced a total of 32 usability assessment instruments and 66 custom-made, as well as hybrid, instruments. Information on psychometric properties was included for 9 (28%) instruments with satisfactory internal consistency and structural validity. A lack of reliability, responsiveness, and cross-cultural validity data was found. The methodological quality of the systematic reviews was limited, with 8 (67%) studies displaying 2 or more critical weaknesses. CONCLUSIONS: There is significant diversity in the usability assessment of mHealth for rehabilitation, and a link to theoretical models is often lacking. There is widespread use of custom-made instruments, and preexisting instruments often do not display sufficient psychometric strength. As a result, existing mHealth usability evaluations are difficult to compare. It is proposed that multimethod usability assessment is used and that, in the selection of usability assessment instruments, there is a focus on explicit reference to their theoretical underpinning and acceptable psychometric properties. This could be facilitated by a closer collaboration between researchers, developers, and clinicians throughout the phases of mHealth tool development. TRIAL REGISTRATION: PROSPERO CRD42022338785; https://www.crd.york.ac.uk/prospero/#recordDetails.

Efficacy of spiritual interventions in palliative care: An umbrella review of systematic reviews.

BACKGROUND: Spiritual care is increasingly recognised as an essential component of care in palliative settings. Given this growing body of literature on spiritual interventions, there is a need to systematically evaluate and synthesis findings from previous systematic reviews. AIM: To systematically synthesise the available evidence from systematic reviews concerning (a) the efficacy of spiritual care interventions and (b) the extent and nature of spiritual care interventions used in specialist palliative care settings. METHODS: An umbrella review of systematic reviews was conducted in accordance with PROSPERO (CRD42024455147) and followed the Joanna Briggs Institute methodology for umbrella reviews. DATA SOURCES: Electronic databases (Ovid Medline, Embase, APA PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Web of Science) and references of accepted systematic reviews were searched for systematic reviews from inception to 2024. The AMSTAR-2 criteria was used to assess risk of bias within systematic reviews. RESULTS: A toal of 27 reviews met the eligibility criteria and reported the effects of 14 different spiritual care interventions across 431 studies including 55,759 participants. Findings show that spiritual care interventions especially dignity therapy and life-review may be effective for improving outcomes including spiritual wellbeing, emotional symptoms, quality-of-life and physical symptoms in people receiving specialist palliative care. Under half of included reviews report follow-up data where only emotional symptoms and quality-of-life are reported in more than one review. CONCLUSION: Overall, spiritual care interventions have positive effects on spiritual wellbeing, quality of life and mood, compared to control conditions. Increased methodological rigour is needed to capture effect and duration of effect with spiritual care interventions at different phases of palliative care.

Dietary sodium intake restriction in patients with heart failure: an overview of systematic reviews.

This study aimed to identify, assess, and summarize systematic reviews on dietary sodium intake restrictions for patients with heart failure. Literature searches were conducted on Pubmed, CINAHL, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure, and the Wanfang Database up to January 2024. The methodological quality of the included reviews was assessed using the quality assessment tool from the Australian JBI Center for Evidence-Based Healthcare (2016). The results of systematic reviews and meta-analyses were synthesized and presented according to different outcome indicators. Nine systematic reviews were included in this study. The current evidence does not support the fact that dietary sodium intake restrictions for patients with heart failure have a positive impact on mortality rates, rehospitalization rates, and quality of life. Conversely, strict dietary sodium intake restrictions (≤ 2000 mg/day) may increase the risk of death, rehospitalization, and symptom exacerbation. Dietary sodium intake restriction may not have a positive impact on clinical outcomes in patients with heart failure. Nevertheless, more evidence is required to explore the differences in the impact of various levels of dietary sodium restriction on the outcomes and symptom management indicators of patients with heart failure.

Current therapeutic overview and future perspectives regarding the treatment of psoriasis.

Psoriasis is a chronic inflammatory skin disease affecting millions of people worldwide, characterized by rapid proliferation of keratinocytes, immune cell infiltration, and systemic inflammation. Over time, treatment strategies have evolved significantly from traditional topical therapies and phototherapy to advanced systemic options such as biologics and, more recently, oral small molecule drugs. This review aims to provide an in-depth examination of current psoriasis therapies, with a focus on biologics, oral small molecules, and new and emerging treatments. Several classes of biologic therapies have received regulatory approval for psoriasis, including inhibitors of TNF-α, IL-12/23, IL-17, and IL-23. Biologics have transformed psoriasis care, offering improved disease management and quality of life for patients, with generally favorable safety profiles. However, challenges such as high cost, potential immunogenicity and complexity of administration have sparked interest in alternative treatment options. Oral small molecules, particularly Janus kinase (JAK) inhibitors, have gained attention for their efficacy and ease of use, being orally administered drugs. These drugs mark a shift in therapeutic paradigms by providing an oral option that precisely targets specific signaling pathways. In addition to existing therapies, this review also highlights emerging treatments that could shape the future of psoriasis care, including new small-molecule inhibitors. Early clinical trials suggest that these agents could improve treatment outcomes for psoriasis patients. Current research is increasingly focused on understanding disease recurrence, particularly the influence of tissue-resident memory T cells (TRMs). Avoiding the proliferation of these cells may be crucial in attenuating recurrence. In particular, interleukin-23 (IL-23), produced by CD301b+ cells, has been linked to stimulation of TRM cell proliferation in the skin. This finding highlights that IL-23 inhibitors and treatments targeting CD301b+ cells are promising strategies for maintaining remission and preventing relapse. In summary, the landscape of psoriasis treatments is advancing rapidly, with an increasing focus on personalized, patient-specific therapies. Research is expected to continue to refine and improve therapeutic approaches for this complex disease.

The safety and effectiveness of music medicine as an intervention for depression: A systematic evaluation and re-evaluation.

BACKGROUND: As the methodological quality and evidence level of the existing systematic reviews (SRs) on music as an intervention for depression have not been thoroughly evaluated, a systematic evaluation and re-evaluation (SERE) was conducted. METHODS: Multiple databases including PubMed, Web of Science, Embase, China National Knowledge Infrastructure, SinoMed, Wanfang, and the VIP database were searched for SRs and meta-analyses (MAs) on the effectiveness of music as an intervention for depression. The literature screening, evaluation of methodological quality, and assessment of evidence level were carried out by a team of researchers. The methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) scale in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were utilized to assess the level of evidence. RESULTS: A total of 18 SRs were included in the analysis. The 2020 PRISMA guidelines were utilized to evaluate various aspects such as search terms, funding sources, statistical methods for missing values, subgroup and sensitivity analyses, certainty assessment, excluded literature citations, assessment of publication bias, protocol information, conflicts of interest, and data availability, which were rarely reported. The evaluation of the studies using the AMSTAR 2 scale revealed that one article was rated as high quality, six were rated as low quality, and 11 were rated as very low quality. Based on the GRADE criteria evaluation, the quality of the evidence was found to be inconsistent, with reports primarily consisting of medium-quality evidence. CONCLUSION: The methodological quality of SRs/MAs of music as an intervention in depression is generally poor, and the level of evidence is generally low.

Comparative Effectiveness of Decision Aids for Cancer-Screening Decision Making: An Overview of Reviews.

BACKGROUND: Decision aids (DAs), compared to no DAs, help improve the key aspects of shared decision-making, including increased knowledge, discussion frequency, and reduction in decisional conflict. However, systematic reviews have reported varied conclusions on screening uptake, and which DAs are superior to alternative forms in shared decision-making for cancer screening has not been comprehensively reviewed. METHODS: An overview of systematic reviews was performed. Multiple databases were searched up to December 31, 2023, for systematic reviews of randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) of any size that assessed a decision aid aimed to facilitate cancer-screening decision making communications. Dual screening of abstracts and full-text reports, dual data extraction and quality assessment, and qualitative synthesis were performed. RESULTS: The 22 eligible publications included 24 reviews on cancer screening DAs for a single specific cancer (8, 8, 7, and 1 on prostate, breast, colorectal, and lung cancer, respectively) and three reviews on multiple aggregate cancers. Individual reviews were based on different primary study designs (92 RCTs and 37 NRCSs); each study was infrequently cited (median citation count 2; range 1-9). Although the DAs had variable formats and delivery methods, the reviews generally focused on use and non-use comparisons. DAs decreased the intention or actual uptake for prostate and breast cancer screening, but increased it for colorectal cancer screening. DAs were associated with increased knowledge, well-informed choice, and reduced decisional conflict, regardless of cancer type. Only four reviews on comparative effectiveness between alternative formats of DAs (based on 14 RCTs and 2 NRCSs) failed to conclude on the specific format that was superior to others. DISCUSSION: DAs improve cancer screening shared decision-making by boosting cancer screening knowledge and informed choice and lowering decisional conflict and may facilitate preference-based, individualized screening participation. Comparative data on different cancer screening DAs are limited. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021235957.

Fast-and-frugal decision tree for the rapid critical appraisal of systematic reviews.

Conducting high-quality overviews of reviews (OoR) is time-consuming. Because the quality of systematic reviews (SRs) varies, it is necessary to critically appraise SRs when conducting an OoR. A well-established appraisal tool is A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, which takes about 15-32 min per application. To save time, we developed two fast-and-frugal decision trees (FFTs) for assessing the methodological quality of SR for OoR either during the full-text screening stage (Screening FFT) or to the resulting pool of SRs (Rapid Appraisal FFT). To build a data set for developing the FFT, we identified published AMSTAR 2 appraisals. Overall confidence ratings of the AMSTAR 2 were used as a criterion and the 16 items as cues. One thousand five hundred and nineteen appraisals were obtained from 24 publications and divided into training and test data sets. The resulting Screening FFT consists of three items and correctly identifies all non-critically low-quality SRs (sensitivity of 100%), but has a positive predictive value of 59%. The three-item Rapid Appraisal FFT correctly identifies 80% of the high-quality SRs and correctly identifies 97% of the low-quality SRs, resulting in an accuracy of 95%. The FFTs require about 10% of the 16 AMSTAR 2 items. The Screening FFT may be applied during full-text screening to exclude SRs with critically low quality. The Rapid Appraisal FFT may be applied to the final SR pool to identify SR that might be of high methodological quality.

Effect of ultrasound-attenuation on technological and functional properties of two strains of Lactiplantibacillus plantarum isolated from table olives.

While probiotics have a wide range of beneficial properties, they can also negatively affect the taste or aroma of foods products by resulting in the phenomenon of post-acidification. Ultrasound (US) is a tool to modulate the metabolism of probiotic bacteria, counteracting post-acidification and improving the performance and functional properties of microorganisms without affecting their viability. The purpose of this paper was to evaluate the effect of 10 different combinations of power (20 and 40 %) and duration (2, 4, 6, 8 and 10 min) of US treatment on two functional strains of Lactiplantibacillus plantarum (c16 and c19) isolated from table olives, with the aim of understanding how, some of the main functional and technological traits (viability, acidification, growth profile under different conditions, antibiotic resistance, viability at pH 2.0 and 0.3 % bile salts), were affected. It was found that the effects were strain dependent, and the best results were obtained for strain c19 in the combinations at 20 % for 8 and 10 min and 40 % for 2 min, where an improvement in functional characteristics was found, with some effects on biofilm stability, inhibition of acidification, without adverse results on some technological properties.

Technology-based suicide prevention: An umbrella review.

Background: The objective is to summarize evidence from systematic reviews, scoping reviews, and meta-analyses evaluating the effects of any format of Internet-based, mobile-, or telephone-based intervention as a technology-based intervention in suicide prevention. Materials and Methods: This is an umbrella review, that followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines. An electronic search was done on September 29, 2022. Data were extracted by reviewers and then methodological quality and risk of bias were assessed by A Measurement Tool to Assess Systematic Reviews-2. Statistical analysis was done by STATA version 17. Standard mean difference was extracted from these studies and by random effect model, the overall pooled effect size (ES) was calculated. I2 statistic was used to assess the heterogeneity between studies. For publication bias, the Egger test was used. Results: Six reviews were included in our study, all with moderate quality. The overall sample size was 24631. The ES for standard mean differences of the studies is calculated as - 0.20 with a confidence interval of (-0.26, -0.14). The heterogeneity is found as 58.14%, indicating a moderate-to-substantial one. The Egger test shows publication bias. Conclusion: Our results show that technology-based interventions are effective. We propose more rigorous randomized controlled trials with different control groups to assess the effectiveness of these interventions.

Effect of Periodontal Treatment in Patients with Periodontitis and Diabetes: Review of Systematic Reviews with Meta-Analyses in the Last Five Years.

BACKGROUND: Periodontitis is a chronic infectious-inflammatory pathology, with a high prevalence, which destroys the dental support and, if left untreated, leads to tooth loss. It is associated with other pathologies, particularly diabetes mellitus. OBJECTIVES: Our objective was to conduct a review of systematic reviews with meta-analyses to determine the evidence for periodontal treatment on periodontitis and diabetes. Second, we assessed the risk of bias and methodological quality using the AMSTAR-2 and ROBIS tools. METHODS: We performed bibliographic searches in PubMed/Medline, Embase, Cochrane Central, Dentistry & Oral Sciences Source databases and in the Web of Science (WOS) scientific information service to identify systematic reviews with meta-analyses from the last five years. RESULTS: Eighteen studies that met the inclusion criteria and evaluated 16,247 subjects were included. The most studied parameters were probing pocket depth, clinical attachment level, bleeding on probing and the glycated hemoglobin. Most of the included meta-analyses evaluated adult patients with periodontitis and type 2 diabetes mellitus (T2DM). Most of the meta-analyses considered and assessed by AMSTAR-2 showed significant methodological errors. The risk of bias was the domain with the worst assessment with the ROBIS tool. CONCLUSIONS: Despite the weaknesses of the included meta-analyses in terms of methodological quality and the risk of bias, periodontal treatment and DM treatment appear to contribute to improved clinical outcomes in a bidirectional manner between periodontitis and DM.

The Outcomes of Trauma-Informed Practice in Youth Justice: An Umbrella Review.

Findings of high rates of complex trauma among justice-involved young people have engendered interest in developing trauma-informed youth justice systems. Although there have been several reviews of trauma-informed practice in youth justice settings, uncertainty remains about whether this approach can produce the outcomes expected of youth justice services. In this study we summarize findings from recent systematic reviews and meta-analyses to provide an overview of evidence relevant to implementing trauma-informed youth justice. We conducted an umbrella review of systematic reviews published between 2017 and 2023 that included group-based primary studies of trauma-informed interventions for justice-involved young people. Reviews were located via searches of PsycINFO, PubMedCentral, Embase, Criminal Justice Abstracts with Full Text, and ProQuest. Data extracted from each review included the number and type of primary studies reviewed, and outcomes related to trauma symptomatology, mental health and wellbeing, and justice system involvement. Nine systematic reviews met our inclusion criteria. Improvements in trauma symptoms, mental health and wellbeing, and justice system involvement were documented in each review. The strongest evidence related to the impact of trauma-focused interventions on posttraumatic stress disorder symptoms, but less evidence was available to demonstrate outcomes of organizational level and systemic components of trauma-informed practice. Each review highlighted the need to strengthen the methodological quality of primary studies. Trauma-informed practice should be seriously considered as part of any effort to implement evidence-based youth justice. This should extend beyond treatment of trauma symptomatology to incorporate a broader approach to trauma-informed practice that is organizationally embedded. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-024-00634-5.

A General Overview of Palliative Care in Morocco: Needs Far Beyond Means.

Morocco's approach to developing palliative care is notably constrained, with an almost complete scarcity of laws and regulations in this area. Despite some progress, palliative care remains fragmented and underdeveloped, with persistent disparities in its accessibility and provision. Nationally, there is a lack of sufficient and detailed information about its progress. This paper aims to fill this gap by offering an overview of the history, infrastructure, education, and legislation framework surrounding palliative care in the country. Significant strides have been made since its implementation, but challenges persist, including the need for a comprehensive legislation framework, more trained professionals, and expanded services beyond oncology to other chronic diseases. Strengthening infrastructure and policies is essential to meet the growing needs of Morocco's population.

Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review.

PURPOSE: Intensive care units (ICUs) have significant palliative care needs but lack a reliable care framework. This umbrella review addresses them by synthesising palliative care practices provided at end-of-life to critically ill patients and their families before, during, and after ICU admission. METHODS: Seven databases were systematically searched for systematic reviews, and the umbrella review was conducted according to the guidelines laid out by the Joanna Briggs Institute (JBI). RESULTS: Out of 3122 initial records identified, 40 systematic reviews were included in the synthesis. Six key themes were generated that reflect the palliative and end-of-life care practices in the ICUs and their outcomes. Effective communication and accurate prognostications enabled families to make informed decisions, cope with uncertainty, ease distress, and shorten ICU stays. Inter-team discussions and agreement on a plan are essential before discussing care goals. Recording care preferences prevents unnecessary end-of-life treatments. Exceptional end-of-life care should include symptom management, family support, hydration and nutrition optimisation, avoidance of unhelpful treatments, and bereavement support. Evaluating end-of-life care quality is critical and can be accomplished by seeking family feedback or conducting a survey. CONCLUSION: This umbrella review encapsulates current palliative care practices in ICUs, influencing patient and family outcomes and providing insights into developing an appropriate care framework for critically ill patients needing end-of-life care and their families.

Effectiveness of de-implementation of low-value healthcare practices: an overview of systematic reviews.

BACKGROUND: Reducing low-value care (LVC) is crucial to improve the quality of patient care while increasing the efficient use of scarce healthcare resources. Recently, strategies to de-implement LVC have been mapped against the Expert Recommendation for Implementing Change (ERIC) compilation of strategies. However, such strategies' effectiveness across different healthcare practices has not been addressed. This overview of systematic reviews aimed to investigate the effectiveness of de-implementation initiatives and specific ERIC strategy clusters. METHODS: We searched MEDLINE (Ovid), Epistemonikos.org and Scopus (Elsevier) from 1 January 2010 to 17 April 2023 and used additional search strategies to identify relevant systematic reviews (SRs). Two reviewers independently screened abstracts and full texts against a priori-defined criteria, assessed the SR quality and extracted pre-specified data. We created harvest plots to display the results. RESULTS: Of 46 included SRs, 27 focused on drug treatments, such as antibiotics or opioids, twelve on laboratory tests or diagnostic imaging and seven on other healthcare practices. In categorising de-implementation strategies, SR authors applied different techniques: creating self-developed strategies (n = 12), focussing on specific de-implementation strategies (n = 14) and using published taxonomies (n = 12). Overall, 15 SRs provided evidence for the effectiveness of de-implementation interventions to reduce antibiotic and opioid utilisation. Reduced utilisation, albeit inconsistently significant, was documented in the use of antipsychotics and benzodiazepines, as well as in laboratory tests and diagnostic imaging. Strategies within the adapt and tailor to context, develop stakeholder interrelationships, and change infrastructure and workflow ERIC clusters led to a consistent reduction in LVC practices. CONCLUSION: De-implementation initiatives were effective in reducing medication usage, and inconsistent significant reductions were observed for LVC laboratory tests and imaging. Notably, de-implementation clusters such as change infrastructure and workflow and develop stakeholder interrelationships emerged as the most encouraging avenues. Additionally, we provided suggestions to enhance SR quality, emphasising adherence to guidelines for synthesising complex interventions, prioritising appropriateness of care outcomes, documenting the development process of de-implementation initiatives and ensuring consistent reporting of applied de-implementation strategies. REGISTRATION: OSF Open Science Framework 5ruzw.

Effects of whole-body vibration on bone mineral density in postmenopausal women: an overview of systematic reviews.

OBJECTIVE: The aim of this study is to evaluate the findings of existing systematic reviews (SRs) and provide scientific evidence on the efficacy and safety of whole-body vibration (WBV) in improving bone mineral density (BMD) in postmenopausal women, to provide recommendations and guidance for future high-quality clinical research and SRs. METHODS: We conducted searches in six databases (SinoMed, CNKI, Cochrane Library, Embase, PubMed, Web of Science) from the inception of the databases until July 31, 2023. The language was limited to Chinese or English. The methodological quality, risk of bias, and evidence grade of outcomes were evaluated using AMSTAR-2, ROBIS, and GRADE, respectively. Additionally, the degree of overlap in randomized controlled trials (RCTs) among the SRs was calculated using corrected covered area (CCA). Furthermore, we performed quantitative synthesis or descriptive analysis of the relevant data. All relevant operations were independently conducted by two individuals. RESULTS: A total of 15 SRs were included in the analysis, out of which three were qualitative descriptions and 12 were meta-analyses. According to AMSTAR-2, only two SRs were rated as low or moderate, while the remaining 13 SRs were rated as critically low quality. The ROBIS assessment indicated that seven SRs had a low risk of bias, while 8 SRs had a high risk of bias. The overall findings suggest that WBV does not have a significant advantage in improving BMD in postmenopausal women. Furthermore, the CCA results revealed a high overlap in RCTs across five outcomes among the 15 SRs. Only five SRs reported specific adverse reactions/events experienced by participants after WBV interventions, and none of the SRs reported any severe adverse events. CONCLUSION: The existing evidence cannot establish definitive advantages of WBV in improving BMD in postmenopausal women. Therefore, we do not recommend the use of WBV for improving BMD in postmenopausal women. However, WBV may have potential value in maintaining BMD in postmenopausal women, further research is needed to confirm these findings.