BMJ Open

1. Systematic review and meta-analysis of information source usage: do medical specialists use the best evidence for clinical decision-making?

   CONCLUSIONS: Medical specialists predominantly rely on standalone information sources when addressing clinical questions, while systematically aggregated and interpreted sources such as clinical practice guidelines and point-of-care tools are used less frequently. These findings highlight the need to better understand and address barriers to the use of aggregated information sources in clinical practice.

2. Organ failure type in fatal and near-fatal anaphylaxis: a systematic review

   CONCLUSION: In this review, respiratory failure (primarily bronchospasm) is the most common primary physiological event leading to decompensation in fatal anaphylaxis, particularly for food and drug allergen deaths. Emphasising the significance of respiratory involvement, particularly from bronchospasm, in both patient and clinician facing anaphylaxis treatment guidelines may help further reduce the risk of fatalities. Prospective anaphylaxis management registries or whole population data are...

3. Disclosure experiences in LGBTQ+ healthcare staff: a systematic review and meta-synthesis

   CONCLUSIONS: The findings must be interpreted considering certain limitations, such as the lack of generalisability of studies. However, the findings emphasise the critical need for cultivating trusting and accepting healthcare work environments for LGBTQ+ staff.

4. Understanding influences of care-seeking behaviours for diarrhoeal illnesses: a qualitative meta-synthesis

   CONCLUSIONS: These findings highlight the importance of contextually grounded interventions that improve physical and financial access to care, foster trust in healthcare providers through consistent and effective service delivery and strengthen community engagement around recognising signs of severe illness and the potential benefits of timely treatment. They also underscore the need for future studies to define diarrhoea in locally relevant terms and to clearly define sources of care-seeking,...

5. Prevalence of potentially inappropriate medication prescribing, inappropriate medication use, prescription omission and drug interactions among older adults in Ethiopia: a systematic review and meta-analysis

   CONCLUSIONS AND RELEVANCE: This review found a high prevalence of PIP, PIM, PDDI and PPO among older adults in Ethiopia, with notable heterogeneity across regions. Polypharmacy was associated with PIP, PIM and PDDI, while hypertension showed association with PIP. Despite generally good study quality, the certainty of evidence was low for the included studies due to the cross-sectional design nature, with high heterogeneity. Therefore, these findings should be interpreted cautiously. This study...

6. Challenges in conducting an individual participant data meta-analysis of non-steroidal anti-inflammatory drugs for patients with (sub)acute low back pain: a systematic review and report on data availability

   CONCLUSIONS: This IPD-MA on NSAIDs for (sub)acute LBP could not be completed due to challenges in data acquisition. In future IPD research, researchers should focus on clearer rationale, recent RCTs, improved data-sharing and storing practices.

7. Advanced therapeutic approaches for inherited retinal diseases: an umbrella review

   CONCLUSION: The findings suggest notable improvements in visual acuity, retinal structure and other critical outcomes, with therapies such as cell therapy, gene therapy and stem cell therapy showing promising results in enhancing treatment efficacy. Although there are examples of successes with supportive evidence, the overall evidence is not sufficiently strong to make general recommendations, as studies still need to be evaluated on a case-by-case basis. Further high-quality, large-scale...

8. Prognostic factors for pain intensity and function in individuals with temporomandibular disorders (TMDs): a systematic review and meta-analysis

   CONCLUSIONS: In adults with TMD, pain provoked by movement or palpation and higher pain intensity were consistently associated with less favourable prognoses. Conversely, shorter pain duration and greater pain-free opening were associated with better outcomes. These associations are non-causal and based on low to very low certainty evidence amid methodological heterogeneity. While they may inform risk stratification, they should not guide treatment decisions without confirmatory longitudinal...

9. Impact of portal vein embolisation uses in colorectal liver metastases: evidence from a rapid review

   CONCLUSIONS: PVEfLR is an effective strategy for converting selected patients with initially unresectable CRLM to resectable status, achieving long-term survival comparable to other complex techniques such as ALPPS, although with a different perioperative risk profile. The choice of technique should be individualised based on the patient's anatomy, disease burden and institutional expertise.

10. Effect of medical school initiatives on help seeking for mental health problems among medical students: a systematic review and meta-analysis

    CONCLUSIONS: Overall, the evidence is of very low to low certainty, due to the serious risk of bias in the included studies, most of which used uncontrolled pre-post designs. Interventions with a lived-experience component may improve medical students' help-seeking attitudes. Standard clinical clerkships did not appear to impact personal help seeking, despite multiple previous studies suggesting they reduce stigma, suggesting barriers to help seeking extend beyond stigma and mental health...

11. Causal language jumps and non-alignments between clinical practice guidelines and original studies: a systematic evaluation of diabetes guidelines and their cited evidence

    CONCLUSIONS: Causal language jumps were common among diabetes guidelines. While these jumps are sometimes inevitable, they should always be justified by good causal inference practices.

12. Clinical indication-based diagnostic reference levels in CT: a systematic review

    CONCLUSION: Several factors contribute to dose discrepancies for the same clinical indications in CT imaging, including kilovolt peak and milliampere-second, scan length, number of phases, patient size, reconstruction algorithm, CT scanner age and specifications, underscoring the need for standardised and optimised CT protocols. This review highlighted several challenges, which emphasise the importance of international organisations to standardise the development of NDRL(ci) to improve...

13. A systematic review of the scope and impact of rural primary healthcare innovations using digital health technology

    CONCLUSIONS: Digital health interventions in rural primary healthcare offer significant potential to improve healthcare delivery, reduce costs and enhance patient access, satisfaction and health outcomes. However, careful consideration of factors such as feasibility, consumer and practitioner acceptance, and recognition of limitations is crucial for successful implementation. The review underscores the importance of flexible policies to support emerging digital healthcare solutions, including...

14. Prevalence and associated factors of optimal dietary practices during pregnancy in Ethiopia: a systematic review and meta-analysis

    CONCLUSIONS: Only one in three pregnant women in Ethiopia practises optimal dietary behaviours. Several modifiable individual and sociodemographic factors influence dietary practices. Interventions focusing on improving nutrition knowledge, enhancing attitudes, expanding access to media-based nutrition information and strengthening antenatal nutrition education, particularly for rural and less educated women, may improve dietary practices and pregnancy outcomes.

15. Exploring meaningful outcome domains of recovery following lower limb amputation (LLA) and prosthetic rehabilitation in low- and middle-income (LMIC) settings: a qualitative systematic review

    CONCLUSION: Evidence on meaningful outcomes of prosthetic rehabilitation in LMICs is extremely limited. Findings indicate that access to a comfortable and durable prosthesis enabling work and daily living is central to recovery, alongside social acceptance and independence. These domains may provide initial insights into outcome measurement and development in low-resource settings. Further primary research across diverse LMIC contexts is urgently needed.

16. Prognostic factors for mortality in patients infected with New World hantaviruses: a systematic review and meta-analysis

    INTRODUCTION: One of the challenges in managing patients with hantavirus infection is accurately identifying individuals who are at risk of developing severe disease. Prompt identification of these patients can facilitate critical decisions, such as early referral to an intensive care unit. The identified prognostic factors could be of utility in guiding medical care to enhance the management of hantavirus infection.

17. Building a functional resonance analysis method (FRAM) in healthcare: a systematic review on how steps are reported, defined and supported by data

    CONCLUSION: Most FRAM studies in healthcare do not report all steps of FRAM, and interpretations of key terms differ. FRAM studies should more clearly describe which steps of the method are conducted, and how data is collected and analysed. Refinement of FRAM guidelines, particularly on data use and terminology, would enhance consistency and comparability across studies.

18. Impact of frailty on postoperative delirium in ICU patients aged 65 and older: a systematic review

    CONCLUSION: Frailty appears to be associated with an increased risk of POD in ICU patients aged 65 and older. Given the limited number and heterogeneity of studies, further research is needed to validate this relationship and to inform targeted prevention strategies in critical care.

19. Risk prediction models for detecting a new diagnosis of heart failure within 5 years in the community: a systematic review

    CONCLUSION: Risk prediction models for a new diagnosis of HF in the community performed well, but were at high risk of bias and lacked external validation. Future model development requires appropriate data sources, robust handling of missing data, external validation and clinical testing to assess their impact on earlier HF diagnosis and outcomes.

20. Neurofilament light chain as a potential biomarker of perioperative neurocognitive disorders: a systematic review and meta-analysis

    CONCLUSIONS: This meta-analysis suggests that NfL may be a potential biomarker for POD. Further research is needed to clarify the association between CSF and blood NfL levels and other forms of PND.

21. Assessing the utility of fractional excretion of urea in distinguishing intrinsic and prerenal acute kidney injury in hospitalised patients: a systematic review and meta-analysis

    CONCLUSIONS: FEUN is a biomarker with moderate diagnostic accuracy for differentiating between intrinsic and prerenal AKI in hospitalised patients. Its application could enhance AKI management; however, the high heterogeneity observed in our study highlights the need for further research to evaluate its utility across diverse patient populations and clinical settings.

22. Muslim communities' perspectives and preferences regarding end-of-life symptom management: a systematic review and narrative synthesis

    CONCLUSIONS: Co-design research methods are essential to better understand care priorities within diverse Muslim communities. Meaningful collaboration among patients, families and healthcare professionals is necessary to identify mutually acceptable and beneficial approaches to promote culturally and religiously sensitive end-of-life symptom management.

23. Understanding barriers and facilitators to education and rehabilitation interventions for South Asian people with long-term conditions: a systematic review and meta-ethnography

    CONCLUSIONS: Findings indicate that current group education and rehabilitation interventions are not fully inclusive of South Asian needs, often lacking cultural sensitivity, which impedes engagement. Special attention is required for South Asian women, who can face additional cultural and societal barriers. Addressing these challenges through culturally sensitive care, such as flexible intervention scheduling around religious practices, gender-sensitive adaptations and culturally tailored...

24. Data-driven strategies for model-informed decision-making during the COVID-19 pandemic: a systematic review

    CONCLUSIONS: This review highlights the critical role of data-driven models in guiding COVID-19 response strategies. Evidence supports the combined effectiveness of non-pharmaceutical interventions, robust testing and tracing systems and health infrastructure strengthening. Real-world impact, however, remains dependent on local healthcare capacity, socioeconomic conditions and cultural contexts. Continued research is essential to refine adaptive modelling approaches and strengthen preparedness...

25. Narrative systematic review for autism spectrum disorders screening tools in school settings

    CONCLUSIONS: ASD screening tools vary widely across the globe, with limited standardisation. Evidence is lacking on how ethnicity and socioeconomic status affect their effectiveness in schools. Given the dearth of scientific evidence in this field, collaboration among educators, researchers and policymakers is needed to establish the evidence base for universal screening, identify optimal tools, coordinate their use and ensure their validation for specific populations.

26. Factors influencing participation of patients who had a stroke in rehabilitation shared decision-making: a qualitative meta-synthesis

    CONCLUSION: Through the meta-synthesis of qualitative studies, this research shows that negative emotions and realistic gaps reduce patients' participation in decision-making. While family support helps enhance patients' confidence in decision-making, economic burden affects their decision choices. Additionally, one-way doctor-patient communication, insufficient information support and discontinuity in the rehabilitation service system increase patients' decision-making burden.

27. Self-efficacy in exercise behaviour in persons with a diagnosed condition: a systematic evidence map

    CONCLUSIONS: This paper offers the first ever comprehensive list of empirical publications on self-efficacy in exercise behaviour in persons with pre-existing conditions in the form of a SEM. The research field was as wide as anticipated concerning total numbers, number of individual scales for measuring self-efficacy, as well as range in diagnosed conditions. Most research focusing on advanced age may be due to many diseases only manifesting later in life, and the lack of specification in types...

28. Performance of artificial intelligence in breast cancer screening programmes: a systematic review

    CONCLUSION: Contemporary AI systems show diagnostic performance that is broadly comparable to radiologists and can substantially reduce reading workload, particularly when used as a second reader or triage tool. Emerging prospective evidence supports their safe integration in these roles, although transparent reporting, standardised evaluation and long-term population studies are still required before considering AI as a stand-alone reader. AI may improve workflow efficiency and possibly cancer...

29. Adjuvant effects of vagus nerve stimulation on post-stroke rehabilitation: a systematic review and meta-analysis

    CONCLUSION: The evidence supporting the use of VNS to improve function in stroke patients demonstrates reasonable reliability, a satisfactory degree of consistency and applicability, and suggests a potentially favourable clinical impact.

30. Adjunctive Tongxinluo capsule for patients with acute coronary syndromes undergoing percutaneous coronary intervention: a GRADE-assessed systematic review and meta-analysis of randomised controlled trials

    CONCLUSION: Current evidence suggests that adjunctive TXL may reduce key cardiovascular events and improve symptoms and quality of life in patients with ACS-PCI, without increasing the risk of non-cardiovascular adverse events. However, all findings are based on low-certainty evidence. These results provide preliminary support for the use of TXL as an adjunctive therapy, but high-quality, multicentre RCTs are needed to confirm these effects and inform clinical guidelines.

31. Effectiveness of focal muscle vibrations in improving sensorimotor performance, mobility and strength in spinal cord injury population: a systematic review

    CONCLUSION: Our systematic review of 25 studies, with 21 (84%) reporting positive outcomes, suggests that FMV may improve sensory perception, motor function, mobility and strength in individuals with SCIs, with benefits observed in both limbs. However, substantial heterogeneity in FMV parameters, study designs, participant characteristics and the high prevalence of serious/critical risk of bias (13/25 studies, 52%) limit definitive conclusions. Further research with optimised protocols, larger...

32. Effects of multimodal mobile health interventions on cardiovascular risk factor management in patients with diabetes: a systematic review and meta-analysis

    CONCLUSIONS: Multimodal mHealth interventions are effective in improving several key cardiometabolic parameters, including glycaemic control, blood pressure, lipid profiles and physical activity levels in patients with diabetes. These interventions represent a promising strategy for comprehensive CVD risk factor management in this population.

33. The carbon footprints of single-use and reusable medical devices: a systematic review

    CONCLUSION: Reusable devices are preferable from a climate perspective, though efforts are needed to reduce reprocessing emissions. Co-ordinated interventions are required: policymakers can enable supportive regulation; manufacturers can improve device design; healthcare facilities can optimise reprocessing; and providers can prioritise reusable device procurement and use.

34. Liberal versus restrictive red blood cell transfusion thresholds in acute acquired brain injury: a systematic review and meta-analysis

    CONCLUSIONS: In adults with acute ABI and anaemia, liberal transfusion reduces the risk of unfavourable outcome (high certainty) and possibly improves the chances of good recovery (low certainty) when compared with restrictive transfusion.

35. To assess the clinical utility of composite outcomes in studies examining outcomes of implantable neuromodulation therapies for pain: a systematic review

    BACKGROUND: Implantable neuromodulation therapies are offered to patients with certain refractory pain syndromes. These therapies are resource-intensive and effort-intensive and may be associated with significant adverse effects. Change in pain intensity score, an unidimensional measurement tool, is currently the most used eligibility criteria for patients to receive implanted neuromodulation devices. However, pain is a biopsychosocial phenomenon, and assessment of effectiveness of...

36. Effectiveness of fresh frozen plasma in the resolution of coagulopathy in human patients following hemotoxic snakebites: a systematic review and meta-analysis

    CONCLUSIONS: FFP as an adjunct to antivenom significantly improves coagulopathy resolution in patients with hemotoxic snakebite-induced coagulopathy. However, the certainty of evidence is very low because of methodological limitations, small sample sizes and significant heterogeneity. Although FFP shows promise for rapid coagulopathy correction, mortality benefits are not established, and it should not replace timely antivenom administration or comprehensive supportive care.

37. What is the impact of health literacy on healthcare costs? A systematic review and evidence synthesis

    CONCLUSION: Individual health literacy was found to be negatively associated with a range of healthcare costs, although the supporting evidence was not always robust. Interventions aimed at containing healthcare expenditure should consider this association, while further research is needed to define its nature.

38. Public-private mix for tuberculosis in urban health systems in least-developed, low-income and lower-middle-income countries and territories: a systematic review

    CONCLUSIONS: PPM models can be effective and cost-effective for TB care in urban low- and middle-income countries contexts, particularly when levels of mistrust between public and private sectors are addressed through principles of equal partnership. The evidence indicates that this may be more achievable when an interface organisation manages the partnership.

39. Dual checkpoint inhibitor therapy versus dual targeted therapy of untreated metastatic BRAF-mutant melanoma: a systematic review of randomised controlled trials

    CONCLUSIONS: The evidence base is compatible with a favourable effect of first-line nivolumab plus ipilimumab for adults with untreated metastatic BRAF-mutant melanoma on survival and an unfavourable effect on toxicity when compared with first-line TT. Future RCTs could provide more data on therapy failure and quality of life.

40. Association between carotid-femoral pulse wave velocity and cardiovascular disease in individuals with moderate blood pressure: a systematic review and individual participant meta-analysis

    CONCLUSIONS: Adding cfPWV to traditional CV risk factors may improve the prediction and classification of first CV events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiations.

41. Patient satisfaction with infection prevention and control interventions in acute hospitals: a systematic review and meta-analysis

    CONCLUSION: Sixty-nine percent of isolated patients reported satisfaction with their care. Patient satisfaction with IPC interventions varies widely, highlighting limitations in current measurement approaches. Strengthening PPI in the design and evaluation of satisfaction measures is essential to capture meaningful data and improvements in IPC programmes.

42. Barriers and facilitators of deceased organ donation among Pakistanis living globally: a systematic review

    CONCLUSION: This review shows that decisions about deceased organ donation are shaped by family dynamics, religious beliefs and trust in healthcare. More diverse research is needed to uncover new gaps and improve donor registration and consent rates in Pakistan. A whole-systems approach, considering families, religion and trust, is essential for effective strategies.

43. Effectiveness of digital physiotherapy interventions in patients with knee osteoarthritis: a systematic review and meta-analysis of randomised controlled trials

    CONCLUSION: There was moderate-quality evidence to support the use of digital physiotherapy interventions in improving pain and function in patients with knee osteoarthritis. Subgroup analyses revealed low-to-moderate quality evidence in using video-conferencing and app-/web-based physiotherapy and interventions with exercise components to treat patients with knee osteoarthritis. Overall, there were limited high-quality trials in drawing a robust conclusion. High ROB and huge heterogeneity were...

44. Access to quality trauma care after injury in Pakistan: a systematic review and narrative synthesis

    CONCLUSION: Our findings highlighted the scarcity of available literature, identified barriers and facilitators and pre-existing interventions, which informed the need to develop feasible, sustainable and contextually relevant interventions to improve access to quality trauma care after injury in Pakistan.

45. Perceptions and experiences of factors determining the inappropriate use and timely removal of indwelling urinary catheters in hospitals and nursing homes: a qualitative evidence synthesis

    CONCLUSION: Key drivers of inappropriate IUC use are vague indications and routine decisions, lack of suitable and available alternatives, staff shortages and perceived lack of importance of the topic. Addressing these barriers is important for deimplementing inappropriate IUC use, and multifaceted strategies appear to be the most promising approach to address the multiple factors that drive current IUC misuse.

46. Systematic review and meta-analysis of the non-specific and broader impact of respiratory vaccines on acute lower respiratory infections in young children

    CONCLUSIONS: Our review demonstrated both protective and neutral non-specific effects of respiratory vaccines against ALRI-hospitalisations and related outcomes in young children. Such effects should be considered as part of the full value of a vaccine and how vaccine investments are prioritised. Further research on the impact of respiratory vaccines on antibiotic prescribing rates is essential as consistent reductions may help contribute to reducing the global burden of antimicrobial...

47. Prevalence of depression or depressive symptoms among engineering students: a systematic review and meta-analysis

    CONCLUSIONS: Prevalence of depression and depressive symptoms is high among engineering students, at levels comparable to medical students. Given the substantial impact, further research should investigate risk factors and evaluate preventive, early detection and treatment strategies tailored to engineering students.

48. Role of recruitment bias in stepped-wedge cluster randomised controlled trials: a systematic review

    CONCLUSIONS: The review revealed that SW-CRTs are prone to recruitment bias, but the risks are comparable to cluster RCTs. When SW-CRTs are unable to recruit prior to randomisation, mitigation strategies could be implemented to reduce bias. A separate tool for RoB assessment in SW-CRTs is required to address the complexities of this trial design.

49. Folate exposures and risk of colorectal cancer: an umbrella review of meta-analyses of observational studies and randomised controlled trials

    CONCLUSIONS: These findings suggest that consuming dietary folate and total folate intake may be beneficial in CRC primary prevention. Specifically, folic acid supplements may inhibit colorectal carcinogenesis in normal tissues while promoting cancer in the established neoplastic foci.

50. Impact of clinical decision support software on empirical antibiotic prescribing and patient outcomes: a systematic review and meta-analysis

    CONCLUSIONS: CDSS can be used to reduce the unnecessary prescribing of broad-spectrum antibiotics. Further high-quality studies are required to establish whether their implementation also results in improvements in other outcomes.