Effects of mindfulness-based preoperative intervention for patients undergoing elective surgery: A meta-analysis.

OBJECTIVE: Patients often experience pain and psychological distress when undergoing elective surgeries. Mindfulness-based interventions have been proposed as potential strategies to address these challenges. This meta-analysis aims to evaluate the efficacy of preoperative mindfulness-based interventions on several outcomes for patients undergoing elective surgery, including preoperative anxiety/depression, postoperative anxiety/depression, postoperative pain, and quality of life (QOL). METHODS: This meta-analysis encompassed randomized controlled trials published in the database PubMed, Cochrane, and Embase to August 2023. Mindfulness-based interventions were compared to control groups, who received treatment as usual (TAU). The RevMan software was employed to assess each outcome by using standardized mean difference based on patient-reported data. Subgroup analyses were further performed according to different categories of surgical types. RESULTS: Eight RCTs with a total of 685 patients were identified. This meta-analysis demonstrated significant difference in preoperative anxiety (SMD:-0.36, 95% CI: -0.62 to -0.11, p = .006) and postoperative pain immediately (SMD:-0.65,95% CI: -1.09 to -0.20, p = .004), 2-3 days (SMD:-0.40, 95% CI:-0.78 to -0.02, p = .04),at 14 days (SMD:-0.48,95% CI: -0.85 to -0.12, p = .009) and 28 days (SMD:-0.89,95% CI: -1.55 to -0.23, p = .008) postoperatively. However, there were no differences between postoperative anxiety, preoperative/postoperative depression, and QOL. CONCLUSION: Our findings suggest preoperative mindfulness-based interventions can effectively manage preoperative anxiety and postoperative pain in patients scheduled for elective surgery. Further research is warranted to explore the different timing and types of mindfulness-based intervention.

Stem cell-derived conditioned medium for alopecia: A systematic review and meta-analysis.

BACKGROUND: Alopecia is a common and distressing medical condition that has been related to psychiatric disorders. Stem cell-derived conditioned medium (CM), a novel therapy for hair regeneration, has shown effectiveness in several trials. METHODS: This meta-analysis aims to explore the effectiveness of stem cell-derived CM in improving hair growth for patients of alopecia. We prospectively registered this systematic review and meta-analysis in PROSPERO (CRD42023410249). Clinical trials that the enrolled participants suffering from alopecia applied stem cell-derived CM were included. We calculated the mean and standard deviation for the hair density and thickness. RESULTS: Ten clinical trials were included in our analysis. On the basis of eight clinical trials (n = 221), our pooled results indicate that stem cell-derived CM is effective in increasing hair density (mean difference [MD]: 14.93, confidence interval [95% CI]: 10.20-19.67, p < 0.0001) and thickness (MD: 18.67, 95% CI: 2.75-34.59, p < 0.0001) (µm) in patients with alopecia. Moreover, our findings suggest that longer treatment duration is associated with significantly greater improvement than shorter treatment duration (p = 0.02). Three of the included studies were randomized controlled trials (RCTs), and when we specifically analyzed these RCTs; statistical significance could also be observed in terms of hair density (MD: 9.23, 95% CI: 1.79-16.68, p < 0.00001). KEY MESSAGES: Stem cell-derived conditioned medium can effectively increase hair density and thickness for alopecia, and there is no difference between each method (topical application, microneedling, or injection).

Effects of Oral Collagen for Skin Anti-Aging: A Systematic Review and Meta-Analysis.

This paper presents a systematic review and meta-analysis of 26 randomized controlled trials (RCTs) involving 1721 patients to assess the effects of hydrolyzed collagen (HC) supplementation on skin hydration and elasticity. The results showed that HC supplementation significantly improved skin hydration (test for overall effect: Z = 4.94, p < 0.00001) and elasticity (test for overall effect: Z = 4.49, p < 0.00001) compared to the placebo group. Subgroup analyses demonstrated that the effects of HC supplementation on skin hydration varied based on the source of collagen and the duration of supplementation. However, there were no significant differences in the effects of different sources (p = 0.21) of collagen or corresponding measurements (p = 0.06) on skin elasticity. The study also identified several biases in the included RCTs. Overall, the findings suggest that HC supplementation can have positive effects on skin health, but further large-scale randomized control trials are necessary to confirm these findings.

The effect of virtual reality on cognitive, affective, and psychomotor outcomes in nursing staffs: systematic review and meta-analysis.

BACKGROUND: In the healthcare systems of the world, reinforcing the competence and professionalism of nurses has become a concern. Gaining clinical nursing competence in the healthcare system requires more effort, and additional training is required. Medical education and training have begun using digital technologies, such as virtual reality (VR). The purpose of this research was to examine the efficacy of VR in terms of cognitive, emotional, and psychomotor outcomes and learning satisfaction in nurses. METHOD: The study searched eight databases (Cochrane library, EBSCOHost, Embase, OVID MEDLINE, ProQuest, PubMed, Scopus, and Web of Science) for articles that met these criteria: (i) nursing staff, (ii) any virtual reality technology intervention for education, all levels of immersion, [1] randomized control trial and quasi-experiment study, and (iv) published articles and unpublished theses. The standardized mean difference was measured. The random effect model was applied to measure the main outcome of the study with a significance level of p < .05. The I2 statistic assessment was applied to identify the level of heterogeneity of the study. RESULTS: A total of 6740 studies were identified, of which 12 studies with 1470 participants met the criteria for inclusion. The meta-analysis showed a significant improvement in the cognitive aspect (standardized mean difference [SMD] = 1.48; 95% CI = 0.33-2.63; p = .011, I2 = 94.88%), the affective aspect (SMD = 0.59; 95% CI = 0.34-0.86; p < .001, I2 = 34.33%), the psychomotor aspect (SMD = 0.901; 95% CI = 0.49-1.31; p < .001, I2 = 80.33%), and learning satisfaction (SMD = 0.47; 95% CI = 0.17-0.77; p = .002, I2 = 0%) aspects of the groups that received the VR intervention compared to the control groups. Subgroup analysis found that dependent variables (e.g., level of immersion) did not improve study outcomes. The quality of evidence was low which is affected by major methodological issues. CONCLUSIONS: VR may favorable as alternative method to increase nurse competencies. Randomized controlled trials (RCTs) on larger samples are needed to strengthen the evidence for the effect of VR in various clinical nurse settings. ROSPERO registration number: CRD42022301260.

Incidence of postoperative delirium in older adults undergoing surgical procedures: A systematic literature review and meta-analysis.

BACKGROUND: With the increase in life expectancy around the globe, the incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation in the incidence of POD, from 4% to 53%, with a lack of specific evidence about the incidence of POD by specific surgery type among older people. The aim of this systematic review and meta-analysis was to determine the incidence of POD by surgery type within populations 65 years and over. METHODS: Databases including PubMed, Cochrane library, Embase, and CINAHL were searched until October 2020. Due to the relatively higher number of meta-analyses undertaken in this area of research, a streamlined systematic meta-analysis was proposed. RESULTS: A total of 28 meta-analyses (comprising 284 individual studies) were reviewed. Data from relevant individual studies (n = 90) were extracted and included in the current study. Studies were grouped into eight surgery types and the incidence of POD for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, and mixed surgeries was 20%, 14%, 13%, 32%, 14%, 30%, 10%, and 26%, respectively. POD detection instruments were different across the studies, with Confusion Assessment Method (CAM & CAM-ICU) being the most frequently adopted. LINKING EVIDENCE TO ACTION: This study showed that POD incidence in older people undergoing surgery varied widely across surgery type. The more complex surgeries like cardiac and abdominal surgeries were associated with a higher risk of POD. This highlights the need to include the level of surgery complexity as a risk factor in preoperative assessments.

Effect of dietary patterns on cognitive functions of older adults: A systematic review and meta-analysis of randomized controlled trials: Dietary Patterns on Cognition of Older Adults.

BACKGROUND: Dietary patterns are associated with cognitive benefits, but inconsistent findings have been reported concerning this association. This study aims to provide a more comprehensive review and higher evidence level by evaluating evidence from randomized controlled trials (RCTs) exploring effects of various dietary patterns on cognitive function outcomes in older adults. METHODS: This systematic review and meta-analysis study followed the PRISMA guidelines. Twelves search engines and databases were searched for papers published up until March 2022. Random-effects models were used to calculate effect size (ES). RESULTS: Twenty-two RCTs met our inclusion criteria. A wide range of cognitive measures were used across the included studies. To reduce heterogeneity and to ensure a sufficient number of studies for meaningful interpretation, we utilized global cognition as the outcome measure. Only nine studies used global cognition measures, including the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Cognitive Abilities Screening Instrument (CASI), or neuropsychological test battery. Additionally, seven dietary patterns were identified in these studies. The results demonstrated that dietary patterns achieved a significant improvement on cognitive function outcomes including the MMSE/CASI (ES = 0.303; 95% CI [0.045, 0.560]), the ADAS-Cog (ES = -0.277; 95% CI [-0.515, -0.039]), and the cognitive battery (ES = 0.132; 95% CI [0.010, 0.255]). CONCLUSIONS: Multidisciplinary health-care professionals may use this information as a reference when planning elder care. More large-scale, high-quality studies are required to explore the long-term effects of healthy dietary patterns on global cognition, other cognitive domains, and life quality among older adults.

Cold intervention for relieving migraine symptoms: A systematic review and meta-analysis.

AIMS: To evaluate the effectiveness of the cold intervention on relieving migraine symptoms among adult patients with migraine. DESIGNS: A systematic review and meta-analysis of randomised controlled trials (RCT) and non-RCT studies were performed. DATA SOURCES: We searched five electronic databases including Cochrane Library and Cochrane CENTRAL, Embase, MEDLINE, Scopus and CINAHL from the date of inception to March 2021. REVIEW METHODS: Research was eligible for the systematic review if they included adult patients with migraine, using cold regimen as intervention, and outcomes measuring the symptom alleviation of migraine. Two researchers independently conducted the searching process and data extraction. The certainty of evidence was assessed using GRADE approach to the main outcomes was used. The PRISMA checklist was used to assure the quality and transparency of report. RESULTS: Six studies (4 RCTs and 2 non-RCTs) met the inclusion criteria. The cold interventions on migraine alleviation include a cold-gel headband, cold-gel cap, intraoral cooling, skin temperature biofeedback and cold wrap accompanied by massage. Compared to non-cold regimens, the cold interventions had a short-term effect on reducing migraine pain rated on the Visual Analog Scale (VAS) score at 30 min after intervention (Std. mean difference [SMD] -3.21; 95% CI -5.94, -0.48). Compared to the non-cold regimens, the cold interventions had marginal long-term effects on relieving migraine pain VAS score (SMD -0.44; 95% CI -0.91, 0.03) and nausea (SMD -0.56; 95% CI -1.17, 0.04) (24 h after intervention). The GRADE indicated that the certainty of evidence was rated from very low to moderate. Insufficient results on the outcomes of nausea and vomiting were discovered for the meta-analysis. CONCLUSIONS: Cold intervention is an effective regimen to reduce migraine pain instantly. The long-term effect of cold interventions on migraine is not demonstrated. The effects of cold interventions on nausea and vomiting need more studies to verify.

Effects of High-Frequency Chest Wall Oscillation on Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Purpose: This study aimed to evaluate the efficacy of high-frequency chest wall oscillation for sputum expectoration and hospital length of stay in patients with acute exacerbations of chronic obstructive pulmonary disease. The improvements in pulmonary function and oxygenation were also investigated. Patients and Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Automated literature database searches were conducted from the earliest records to March 31, 2022. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB 2.0), and meta-analysis software (RevMan 5.4) was used to analyze the data. Results: From 5439 identified articles, 13 studies (with 756 patients) were included in this meta-analysis. Compared to other airway clearance techniques, HFCWO significantly increased expectorated sputum volume by 6.18 mL (95% CI: 1.71 to 10.64; I2 = 87%), shortened hospital stay by 4.37 days (95% CI: -7.70 to -1.05; I2 = 84%). However, FEV1 (%), PaO2, and PaCO2 did not improve significantly. Conclusion: AECOPD patients may benefit from HFCWO therapy. HFCWO enables AECOPD patients to excrete more sputum and shorten their hospital stays. However, due to heterogeneity among the included research, these results should be interpreted with caution.

Combination of radiofrequency ablation and percutaneous ethanol injection versus radiofrequency ablation alone for hepatocellular carcinoma: a systematic review and meta-analysis.

INTRODUCTION: Radiofrequency ablation and percutaneous ethanol injection are important treatment modalities for hepatocellular carcinoma patients; Whether a combination treatment yields, additional benefit still remains controversial. METHODS: A systematic review and meta-analysis was concluded. Randomized controlled trials published before January 1, 2022, from PubMed, EMBASE, Scopus, and CNKI were searched. Studies were excluded when patients received different ablative treatment or had serious liver dysfunction. The risk of bias assessment was evaluated using the Cochrane Collaboration's tool. RESULTS: Ten studies, encompassing 854 patients, with histologically proven HCC were finally analyzed. The results demonstrated that patients who received RFA-PEI had slightly improvements in 1-year overall survival (OS) [risk ratio (RR): 1.11; 95% confidence interval (CI): 1.03, 1.19, I2 = 10%], 2-year OS (RR: 1.25; 95% CI: 1.12, 1.40, I2 = 0%), 3-year OS (RR: 1.42; 95% CI: 1.11, 1.83, I2 = 38%), 1-year local recurrence-free (LRF) proportion (RR: 1.2; 95% CI: 1.01, 1.42, I2 = 61%), and complete tumor necrosis (CTN) (RR: 1.32; 95% CI: 1.14, 1.53, I2 = 45%). Nevertheless, common complications, such as fever, were found to be significant (RR: 1.78, 95% CI: 1.13, 2.80). CONCLUSION: Despite RFA-PEI appearing to be superior for HCC patients with a compensated liver in terms of OS, current evidence contained moderate to significant heterogeneity, and it was difficult to draw a definite conclusion regarding the therapeutic management in terms of LRF and CTN.

Recognizing Intensive Care Unit Delirium: Are Critical Care Nurses Ready?

BACKGROUND: Delirium remains significantly undetected in the intensive care unit (ICU). Little is known regarding the level of delirium care knowledge among critical care nurses in Taiwan. PURPOSE: This study was designed to investigate the level of knowledge about delirium care among critical care nurses using a multiple-choice question quiz. METHODS: A descriptive, cross-sectional approach was used, and data were collected using a web-based survey. The demographic characteristics including age, years worked as critical care nurse, gender, advanced ICU training, educational level, and type of ICU, along with a delirium care knowledge quiz, were collected. The quiz consisted of 16 items measuring (a) symptoms, types, and outcomes; (b) high-risk groups; (c) predisposing and precipitating factors; and (d) assessment and detection of delirium. Data were collected between October 6 and November 16, 2020. RESULTS: In total, 324 critical care nurses completed the survey. The rate of correct response on the delirium care quiz for each domain was measured: (a) symptoms, types, and outcomes: 67.1%; (b) high-risk groups: 76.2%; (c) predisposing and precipitating factors: 78.9%; and (d) assessment and detection: 41.5%. The item with the lowest correct response rate was related to the interpretation of delirium assessments. CONCLUSION/IMPLICATIONS FOR PRACTICE: The findings of this study suggest that future studies and education should focus on the use and interpretation of the assessment using a valid delirium assessment tool to improve the ability of critical care nurses to detect delirium in ICU settings.

Optimal timing and effect of music therapy in patients with burn injuries: Systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Burn injuries may have both physiological and psychological consequences. Numerous studies have reported the use of music therapy during burn injury treatment, but the optimal timing for music therapy remains unclear. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials on patients with burn injuries to analyze the effects of music intervention on them at different timings: background (T0) and time before (T1), during (T2), and after (T3) change dressing (CD). METHOD: The PubMed and EMBASE databases were searched for articles published before Novenber 2020 based on predetermined criteria. Our search focused on two keywords: music and burn. Reviewers extracted data from all eligible studies independently. The I2 statistic was used to determine statistical heterogeneity. The endpoints included standardized mean differences (SMDs) and 95% confidence intervals (CIs). Relevant Forest plots were also created. RESULT: This study finally included seven trials recruiting a total of 524 patients. The results indicated that compared with non-music intervention, music intervention significantly reduced anxiety at T0 (SMD = -1.32, 95% CI [-2.61, -0.02], T1 (SMD = -2.15, 95% CI [-4.30, -0.00]) and T2 (SMD = -0.39, 95% CI [-0.74, -0.04]). Moreover, they also significantly reduced the pain levels at T0 (SMD = -1.59, 95% CI [-2.00, -1.17]) and T2 (SMD = -0.47, 95% CI [-0.82, -0.12]), improved the mental condition, and reduced the amount of opioid analgesics used at T0. CONCLUSION: Music therapy seems to have some effects at T0 and T1 in patients with burn injuries. Music therapy was more effective in improving psychological outcomes than physiological outcomes. However, additional high-quality studies related to music therapy for patients with burn injuries are warranted.

Efficacy and safety of botulinum toxin for treating sialorrhea: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Sialorrhea often happens in patients with neurologic disorders, and botulinum toxin (BoNT), which inhibits acetylcholine activation, may be an effective treatment for drooling. This systematic review and meta-analysis of randomized control trials aims to evaluate the efficacy and safety of BoNT in adults and children with sialorrhea due to neurological disorders. METHODS: The PubMed, Embase, and Cochrane databases were searched for relevant studies published before August 2021. The pooled estimate of outcomes was calculated using a random effect model. RESULTS: The review included 17 studies involving 981 patients. Compared with placebo, both BoNT type A (BoNT-A) and BoNT type B (BoNT-B) alleviated drooling frequency and severity (mean difference, 95% CI; BoNT-A: -1.20, -1.89 to -0.51; BoNT-B: -1.62, -2.07 to -1.17), reduced saliva weight (BoNT-A: -1.70, -2.30 to -1.10; BoNT-B: -1.12, -1.97 to -0.27), and improved global impression of change (BoNT-A: -1.30, -1.73 to -0.86; BoNT-B: -1.58, -1.95 to -1.21) in adults 4 weeks postinjection. BoNT-B remained effective at 12 weeks. In children, BoNT-A and BoNT-B alleviated sialorrhea symptoms (BoNT-A: -1.63, -2.42 to -0.85; BoNT-B: -5.20, -6.03 to -4.37) and BoNT-A reduced saliva weight (-0.77, -1.54 to 0.00) at 4 weeks postinjection. After 12 weeks, BoNT-B remained efficacious. Most adverse effects (AEs) were mild to moderate and self-limited. CONCLUSIONS: There is moderate certainty of evidence (COE) that either BoNT-A or BoNT-B could relieve sialorrhea after 4 and 12 weeks of follow-up without significantly more severe AEs in adults. However, the COE is very low to low in children.

The Effect of Paternal Skin-to-Skin Care: A Systematic Review and Meta-analysis of Randomized Control Trials.

BACKGROUND: Research about skin-to-skin care (SSC) experiences in early period after birth has focused on mothers and infants. PURPOSE: The purpose of this study was to determine the outcomes of paternal skin-to-skin care (P-SSC) in both fathers and infants. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, CINAHL, PsycInfo, Airiti Library, and Google Scholar were searched for randomized controlled trials (RCTs) that reported outcomes of P-SSC in both fathers and infants. We calculated pooled mean differences (MDs) and 95% confidence intervals (CIs) using RevMan 5.3 for the meta-analysis [PROSPERO: CRD42018106790]. RESULTS: Seven RCTs including a total of 552 participants were eligible for inclusion. Compared to the maternal skin-to-skin care (M-SSC), fathers in the P-SSC exhibited no significant differences in salivary oxytocin levels (MD: -0.35 pg/mL; 95% CI: -0.75, 0.05), salivary cortisol levels (MD: 0.25 µg/dL; 95% CI: -0.82, 1.33), or anxiety scores (MD: -0.17; 95% CI: -0.57, 0.22) during the period of SSC. Similarly, there were no significant differences in the salivary cortisol levels (MD: -0.11 µg/dL; 95% CI: -0.05, 0.28) among preterm infants between the 2 groups. However, the crying time was less among full-term infants in the P-SSC group compared with infants in the incubator care or cot care groups. IMPLICATIONS FOR PRACTICE AND RESEARCH: P-SSC had similar effects as M-SSC on stress-related outcomes during and after SSC among fathers and infants in the early stages after birth. We recommend that P-SSC be implemented in the early stages after birth. Further RCTs with a longitudinal design and large samples are needed to better understand the long-term effects of P-SSC on fathers and infants.

Relieving from Breathlessness in the Wind: A Meta-Analysis and Subjective Report of Effectiveness of Fan Blowing in Patients with Cardiorespiratory Diseases or Cancer.

OBJECTIVES: Breathlessness is common among terminally ill patients with cardiorespiratory disease or cancer. The experience may induce secondary physiological and behavioral responses that limit patient well-being and independence and cause emotional distress. METHODS: We conducted a meta-analysis on randomized controlled trials (RCTs) that examined the effectiveness of fan blowing on breathlessness among patients with cardiorespiratory diseases or cancer. The PubMed, Cochrane Library, Embase, SCOPUS, and CINAHL databases were searched to retrieve potential articles. The primary outcome was breathlessness severity. The secondary outcomes were SpO2, anxiety, depression, and quality of life. Also, we presented the changes of vital signs and subjective feeling of a male patient who used fan blowing for relieving his breathlessness. RESULTS: Eight RCTs were available for analysis. The pooled results demonstrated no significant difference in breathlessness severity between fan-to-face blowing and control methods (standard mean difference: -0.21, 95% confidence interval: -.59 to .17); however, a significant reduction in breathlessness severity was observed in the short-time intervention compared with long-time intervention. A trend occurred toward significance in the reduction of respiratory rate in fan-to-face blowing compared with control methods (MD: -.64, 95% CI: -1.37 to .09). No differences were observed between groups in oxygen saturation, anxiety, depression, or QoL. The male patient who used fan blowing showed an improved vital signs and a satisfied subjective feeling. CONCLUSIONS: Consistent short-time fan-to-face blowing is effective for relieving breathlessness among conscious terminally ill patients with cardiorespiratory diseases or cancer. The use of this convenient method for relieving breathlessness symptoms in terminally ill patients is recommended.

The Association between Serum Bilirubin and Kernicterus Spectrum Disorder: A Systematic Review and Meta-Analysis.

BACKGROUND: Total serum bilirubin (TSB) is used in managing neonates with jaundice, but clear evidence on its association with major outcomes is lacking. OBJECTIVES: We evaluated the association between TSB and kernicterus spectrum disorder (KSD). METHODS: We searched PubMed, EMBASE, and CENTRAL till July 2021. Two authors independently selected relevant cohort studies, extracted data (CHARMS checklist), assessed risk of bias (RoB) (QUIPS tool), and rated certainty-of-evidence (Grades of Recommendation, Assessment, Development, and Evaluation). We pooled adjusted odds ratio (aOR) (random-effect) via generic inverse variance methods. RESULTS: From 2,826 records retrieved, we included 37 studies (n = 648,979). Fifteen studies had low, 16 moderate, and 6 high RoB, with majority having concerns on confounder adjustment and statistical analysis. Twenty-two studies contributed meta-analysis data, and 15 were summarized narratively. TSB appears associated with KSD in infants with certain risk factors (aOR 1.10, 95% CI: 1.07-1.13; 5 studies [n = 4,484]). However, TSB (aOR 1.10, 95% CI: 0.98-1.23; 1 study [n = 34,533]) or hyperbilirubinemia (aOR 1.00, 95% CI: 0.51-1.95; 2 studies [n = 56,578]) have no clear association with kernicterus or neurological diagnosis in overall neonatal population (moderate-certainty-evidence). One study shows that infants with hyperbilirubinemia appear likelier to develop attention-deficit disorder (aOR 1.90, 95% CI: 1.10-3.28) and autistic spectrum disorder (aOR 1.60, 95% CI: 1.03-2.49, n = 56,019) (low-certainty-evidence). Certain clinical factors appear associated with KSD, although very few studies contributed to the analyses. CONCLUSIONS: Despite the importance of this question, there is insufficient high-quality evidence on the independent prognostic value of TSB for adverse neurodevelopmental outcomes in most neonatal populations. Future studies should incorporate all known risk factors alongside TSB in a multivariable analysis to improve certainty-of-evidence.

Increasing retractions of meta-analyses publications for methodological flaw.

Purpose of this letter was to explore the trends regarding methodological flaws of systematic review and meta-analyses (SRMAs) based on retraction notes in the past decades, and the categories of reasons for the retractions. Content analysis with descriptive statistics, Cochran Q test, and multinomial logistic regression were used. Based on 187 records of retracted SRMAs, retraction announcements can be categorized into academic ethical violation, methodological flaw, and writing or reporting problem. The numbers of academic ethical violation were significantly higher than those with methodological flaw (z = 3.51; p < 0.01) or writing problem (z = 8.58; p < 0.001). The numbers of methodological flaw were also higher than that with writing problem (z = 6.47; p < 0.001). Moreover, an increased proportion of methodological flaw was observed since 2006, and the retraction year was significantly associated with increased proportion of methodological flaw when academic ethical violation as the reference group.

The Optimal Strategy of Vitamin D for Sarcopenia: A Network Meta-Analysis of Randomized Controlled Trials.

Sarcopenia is a disease of gradual loss of muscle mass in elderly people, and the most common treatment options include nutritional supplementation and exercise. Vitamin D has potential beneficial effects for skeletal muscle tissue and has often been included in nutritional therapy formulations. However, the therapeutic effect of vitamin D for the treatment of sarcopenia has not yet been determine and there is a lack of high-quality supporting evidence. We searched three databases for randomized controlled trials (RCTs) on this topic. Changes in hand grip strength, gait speed, chair-stand test, fat mass, relative skeletal muscle index, and muscle mass were assessed for analysis. Network meta-analysis was further employed, based on the frequentist approach. Outcomes were reported as weighted mean differences (WMD) with 95% confidence intervals (CIs). A total of 9 RCTs (n = 1420) met our eligibility criteria, which treated patients with vitamin D (D), protein (P, n = 165), exercise (E, n = 124), iso-caloric product (I, n = 226), usual care without nutritional supplement (n = 65), P + D (n = 467), D + E (n = 72), P + E (n = 69), D + E + I (n = 73), and P + D + E (n = 159). The pooled estimate showed that the P + D + E intervention induced a greater improvement in hand grip strength than iso-caloric product intervention (WMD = 3.86; 95%CI, 0.52-7.21). Vitamin D intervention could lead to shorter chair-stand time (WMD = -1.32; 95%CI, -1.98 to -0.65), but no significant findings could be found for gait speed and muscle mass outcomes. Our synthesis found that combining vitamin D supplementation with protein supplementation and exercise can significantly increase grip strength and also showed a trend toward increasing muscle mass. This result implies that adding vitamin D to a standard treatment protocol for sarcopenia may be helpful for regaining function.

Postoperative Delirium in Older Patients: A Systematic Review of Assessment and Incidence of Postoperative Delirium.

BACKGROUND: Postoperative delirium is the most common complication of surgery particularly in older patients. AIMS: The current study aimed to summarize the commonly used delirium assessment tools in assessing postoperative delirium (POD) and to estimate the incidence rates of POD. METHODS: A systematic review that included empirical cohort studies reporting the use of delirium assessment tools in assessing POD between 2000 and 2019. Five core databases were searched for eligible studies. The methodological quality assessment of the included studies was undertaken using the Joanna Briggs Institute (JBI) critical appraisal checklist to examine the risk of bias. Pooled incidence estimates were calculated using a random effects model. RESULTS: Nineteen studies with a total of 3,533 postsurgery older patients were included in this review. The confusion assessment method (CAM) and CAM-ICU were the most commonly used tools to assess POD among older postoperative patients. The pooled incidence rate of POD was 24% (95% CI [0.20, 0.29]). The pooled incidence estimates for mixed (noncardiac) surgery, orthopedic surgery, and tumor surgery were 23% (95% CI [0.15, 0.31]), 27% (95% CI [0.20, 0.33]), and 19% (95% CI [0.15, 0.22]), respectively. More than 50% of included studies used CAM to assess POD in different types of postoperative patients. Using CAM to assess delirium is less time-consuming and it was suggested as the most efficient tool for POD detection. LINKING EVIDENCE TO ACTION: We identified that CAM could be implemented in different settings for assessing POD. The incidence and risk factors for POD introduced can be used for future research to target these potential indicators. The incidence rate, risk factors, and predictors of POD explored can provide robust evidence for clinical practitioners in their daily practice.

Effects of a simulation-based education programme on delirium care for critical care nurses: A randomized controlled trial.

AIMS: To evaluate the effects of a simulation-based education programme on critical care nurses' knowledge, confidence, competence and clinical performance in providing delirium care. DESIGN: Single-blinded randomized controlled trial. METHODS: Registered nurses who work in intensive care units were recruited from a university-affiliated acute major metropolitan teaching hospital. The intervention group received: (i) five online-learning delirium care videos, (ii) one face-to-face delirium care education session and (iii) a simulation-based education programme with a role-play scenario-based initiative and an objective structured clinical examination. The control group received only online videos which were the same as those provided to the intervention group. Delirium care knowledge, confidence, competence, and clinical performance as outcomes were collected at: baseline, immediately after intervention, and within 6 weeks post-intervention to test whether there were any changes and if they were sustained over time. Data were collected between 2 October and 29 December 2020. The repeated-measures analysis of variance was used to examine for changes in delirium care knowledge, confidence, and competence within groups. RESULTS: Seventy-two critical care nurses participated with 36 each allocated to the intervention group and control group. No statistically significant difference was observed between the two groups in outcome variables at 6 weeks post-intervention. In the intervention group, significant within-group changes were observed in terms of delirium care knowledge, confidence, and competence over time. By contrast, no significant changes were observed in outcome measures over time in the control group. CONCLUSION: The simulation-based education programme is an effective and feasible strategy to improve delirium care by enhancing the knowledge, confidence, competence and clinical performance of critical care nurses. IMPACT: Our findings provide evidence regarding the development and implementation of a simulation-based education programme in hospitals for health professional education in Taiwan.