BMJ Open

1. Low-dose versus high-dose intravenous nitroglycerin in the treatment of sympathetic crashing acute pulmonary oedema: a systematic review and meta-analysis focusing on efficacy, safety and outcomes

   CONCLUSIONS: High-dose NTG improved clinical outcomes in SCAPE, reducing mechanical ventilation need, symptom duration and hospital stay without increased adverse events. These findings suggest high-dose NTG as a promising treatment strategy. Further large-scale studies are needed to optimise dosing protocols.

2. Effectiveness of cognitive stimulation for individuals with mild cognitive impairment: a systematic review and meta-analysis

   CONCLUSION: The CS intervention can effectively improve cognitive function and alleviate depression symptoms. Although a meta-analysis was not conducted for IADL and QoL due to the limited number of included studies, positive trends in enhancing IADL performance and augmenting QoL were observed in individuals with MCI. However, due to the scarcity of relevant studies in this research field, more comprehensive RCTs are warranted to provide a better understanding of the potential benefits of CS...

3. Perinatal outcomes for infants exposed to systemic cancer treatment during gestation: a systematic review and meta-analysis

   CONCLUSION: Very few studies have compared outcomes of systemic therapy-exposed and non-exposed babies of women with gestational cancer. These studies are of limited quality. The available evidence suggests that while some studies indicate a possible association between systemic cancer therapy and increased risk of preterm birth, the overall findings should be interpreted cautiously given the small sample sizes, lack of adjusted analyses, and clinical heterogeneity among included studies....

4. Access to mental healthcare for refugees, asylum seekers and migrants: an umbrella review of barriers

   CONCLUSION: Policy implementation should address the identified barriers and be routinely assessed for efficacy in service delivery and uptake. Future research should focus on enabling the utilisation of mental healthcare services among migrants, asylum seekers, and refugees.

5. Tertiary prevention interventions for patients with stroke in African countries: a systematic review

   CONCLUSION: This systematic review comprises heterogeneous effective interventions for tertiary stroke prevention mostly conducted in small productive research clusters. There is a growing body of research from African countries covering important fields of stroke rehabilitation, including local adaptations of the rehabilitation process and new knowledge concerning transcranial magnetic stimulation. There remains an urgent need to implement interventions aimed at overcoming barriers to stroke...

6. Prevalence and factors influencing fear of disease progression in stroke patients: a systematic review and meta-analysis with a focus on China

   CONCLUSION: The incidence of FoP in Chinese stroke patients is high (56%), influenced by age, education level, economic income, body mass index, social support, illness perception and family intimacy. Despite high heterogeneity, sensitivity analyses confirmed result robustness. Clinical staff should prioritise psychological screening for FoP and implement targeted interventions, such as cognitive-behavioural therapy for negative illness perception, social support programmes for low-income...

7. Risk factors for surgical site infection (SSI) in patients undergoing hysterectomy: a systematic review and meta-analysis

   CONCLUSIONS: The study establishes blood transfusion, tumour presence, obesity, diabetes and tobacco use as significant risk factors for SSI after hysterectomy, with variations in risk evident across different incision types. The findings also suggest vaginal and laparoscopic hysterectomies as preferable alternatives to abdominal hysterectomy in mitigating SSI risk. Future research should aim for more granular data to untangle the interplay between comorbidities and further elucidate the...

8. Effect of nebulised inhalation of antibiotics on preventing ventilator-associated pneumonia in critically ill patients: a systematic review and meta-analysis

   CONCLUSIONS: Nebulised prophylactic antibiotics may reduce the incidence of VAP in critically ill patients receiving mechanical ventilation, though secondary outcomes did not differ between the intervention and control groups. The findings should be interpreted with caution due to the small number of included trials and low certainty of evidence.

9. Interventional effects of modified constraint-induced movement therapy on upper limb function in patients who had a stroke: systematic review and meta-analysis

   CONCLUSION: Low-level evidence suggests that m-CIMT can improve upper limb function in patients who had a stroke, although some indicators exhibit high heterogeneity. Therefore, this conclusion should be interpreted with caution. m-CIMT appears to improve upper limb function in patients who had a stroke with a course duration of more than 2 months, as well as in patients with chronic stroke. The intervention period should be at least 2 weeks, and each training session should last at least 30...

10. Cancer prevalence after exposure to Wnt-activating drugs: a systematic review

    CONCLUSIONS: The current study found that the use of drugs that activate the Wnt pathway was not associated with an increased risk of cancer. As a promising agent in the regenerative therapy field, further research into Wnt activation as a treatment option should be explored.

11. Effects of cupping therapy on chronic musculoskeletal pain and collateral problems: a systematic review and meta-analysis

    CONCLUSIONS: This study indicates that cupping therapy may be efficient in alleviating pain intensity in patients with CMP with immediate effects. But it cannot improve functional disability and mental health significantly.

12. Pharmacotherapy options for the management of subjective tinnitus: a systematic review and network meta-analysis

    CONCLUSIONS: This meta-analysis found that antioxidant supplementation, such as Ginkgo biloba, and vitamins and gamma-aminobutyric acid agonists, represented by acamprosate, could be promising treatments for subjective tinnitus. Further trials with rigorous design and larger sample sizes are necessary to supplement the current evidence.

13. Association between patient activation, self-management behaviours and clinical outcomes in adults with type 2 diabetes: a systematic review with narrative synthesis

    CONCLUSION: A causal relationship between PAct, clinical outcomes and SMBs in T2D cannot be established due to inconsistent evidence and a lack of high-quality studies. Thus, the use of PAct scores as a tailoring tool and an outcome measure in healthcare services requires further evaluation.

14. Current applications of indocyanine green fluorescence angiography in trauma patients and its potential impact: a systematic review

    CONCLUSION: The available literature regarding the use of ICG-FA in trauma surgery is limited, and comparability is low. Still, the results are promising and show a large potential of ICG-FA for better and more efficient treatment of trauma patients. Further research with larger samples and comparable conditions is thus necessary and highly recommended.

15. How do we measure dysarthria after stroke? A systematic review to guide the core outcome set for dysarthria

    CONCLUSIONS: This review provides a comprehensive overview and appraisal of dysarthria measurement instruments to align with a Core Outcome Set. We only included English language-based measurement instruments. Many dysarthria measurement instruments were developed for non-stroke populations, including progressive dysarthria, with limited psychometric data for stroke. Measurement instruments with uncertain quality of evidence can still be considered for inclusion with a Core Outcome Set and three...

16. Completeness of reporting of simulation studies on responder analysis methods and simulation performance: a methodological survey

    CONCLUSION: Simulation studies comparing responder analysis methods exhibit suboptimal reporting quality. Compared with standard binary methods, augmented binary methods, distributional methods and model-based methods may be better choices, but there is no best one.

17. What proportion of people have long-term pain after total hip or knee replacement? An update of a systematic review and meta-analysis

    CONCLUSIONS: Our review suggests that approximately 22% of patients report pain 3 months post-TKR, with 12%-15% experiencing long-term pain up to 2 years. At least 14% report pain 6-12 months after THR. Given the prevalence of chronic postsurgical pain, implementing existing and developing new preventive and management strategies is crucial for optimal patient outcomes.

18. Impact of perioperative esketamine on the perioperative neurocognitive dysfunction: a systematic review and meta-analysis of randomised controlled studies

    CONCLUSION: Perioperative esketamine reduces the risk of short-term PND, including POD and dNCR, without significantly affecting the incidence of adverse events or length of hospital stay. However, no significant differences were observed in the risk of post-NCD at 3 months following surgery. This systematic review and meta-analysis offers valuable data for PND research and clinical drug intervention strategies.

19. Changes in medical student attendance at in-person teaching sessions: a systematic review

    INTRODUCTION: The COVID-19 pandemic has had a significant impact on medical education, with many institutions shifting to online learning to ensure the safety of students and staff. However, there appears to be a decline in in-person attendance at medical schools across the UK and worldwide following the relaxation of social distancing rules and the reinstatement of in-person teaching. Importantly, this trend was also observed before the pandemic. While reflected within the literature, there is...

20. Prevalence of common mental disorders and sleep disorder among adolescents and young adults with HIV: a systematic review and meta-analysis

    CONCLUSIONS: AYA with HIV are a population at high risk of experiencing depression, anxiety, PTSD and sleep disorder. More sensitive screening strategies and more comprehensive intervention methods are needed. However, in view of the high heterogeneity, the differences between studies need to be considered and the pooled estimates interpreted with caution.

21. Communication-based interventions to increase COVID-19 vaccine willingness and uptake: a systematic review with meta-analysis

    CONCLUSION: Overall, we found that education and information-based interventions or social norm-framing strategies are most effective compared with no intervention given. Our findings show that some of the investigated communication strategies might influence policy decision-making, and our results could be useful for future pandemics as well.

22. Psychometric properties of early childhood development assessment tools in low- and middle-income countries: a systematic review

    CONCLUSIONS: Psychometric evidence is fragmented, limited and heterogeneous. More rigorous psychometric analyses, especially on measurement invariance, are needed to establish the quality and accuracy of ECD tools for use in LMICs.

23. Patient-facing online triage tools and clinician decision-making: a systematic review

    CONCLUSION: Clinicians should be aware that their decision-making processes are likely to differ when using online triage tools. Developers can use the findings to improve the usability of the tools to aid clinical decision-making. Future research should focus on patient-facing online triage tools in general practice and the process of clinical decision-making.

24. How do migrants living with HIV adhere to the HIV care process in high-income countries? A systematic review

    BACKGROUND: In high-income countries (HICs), migrants living with HIV (MLHIV) are more likely than other HIV subpopulations to encounter problems which hamper their adherence to the care process; these include social and administrative insecurity, discrimination and psychological distress.

25. Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysis

    CONCLUSION: Breast cancer in Ethiopia poses a high mortality rate primarily due to late-stage diagnosis, rural residency, histologic grade III, positive lymph node status and comorbidities. To improve survival outcomes, it is crucial to expand access to early screening, particularly in rural areas, implement comprehensive treatment protocols and strengthen healthcare infrastructure to address these critical factors.

26. The effect of minimum volume standards in hospitals (MIVOS): a systematic review

    CONCLUSION: This systematic review does not provide conclusive evidence on the effects of minimum volume standards in hospitals regarding any outcomes. The certainty of evidence for mortality (in-hospital; 30 days) is very low and low for complications, reoperations and travel distance. The results are based on a relatively small number of studies for most outcomes. There is a need for studies researching the effects of minimum volume standards based on a robust study design.

27. What if I fail? Unsuccessful smoking cessation attempts and symptoms of depression and anxiety: a systematic review and meta-analysis

    CONCLUSIONS: Most studies indicated a positive trend in alleviating symptoms of anxiety and depression during a quit attempt. Successful quitters experienced more substantial reductions in these symptoms compared with those who were unsuccessful. Importantly, those who made an unsuccessful quit attempt did not experience worse mental health.

28. Exit knowledge about dispensed medications and associated factors among outpatients served in public hospital pharmacies and private pharmacies in Ethiopia: a systematic review and meta-analysis

    CONCLUSION: The systematic review and meta-analysis showed that pooled patient knowledge regarding their dispensed medications in Ethiopia is about 45%. Key determinant factors of knowledge included education level, quality of pharmacist communication, urban versus rural residence and pharmacist politeness. Recommendations for improvement include enhancing pharmacist training, developing educational materials in local languages, outreach programmes for rural areas and implementing...

29. Effects of exercise with music in frail older adults: a systematic review and meta-analysis

    CONCLUSIONS: Exercise with music may help improve frail older adults' physical and emotional health and potentially reduce the burden of frailty. However, further rigorous investigation is needed, as the evidence has a very low level of certainty. Additionally, results from this review should be interpreted with caution because of concerns associated with the risk of bias. Community-based health professionals should consider using music when providing exercise interventions to frail older...

30. Effects of exercise programmes delivered using video technology on physical performance and falls in people aged 60 years and over living in the community: a systematic review and meta-analysis

    CONCLUSIONS: Video-delivered exercise programmes improved physical performance, particularly lower extremity strength, balance and mobility, with low to moderate quality evidence. There is uncertainty about the effect of video-delivered exercise programmes on the number of falls, number of fallers and fear of falling.

31. Mortality among children aged 28 days-17 years with pneumonia who are not severely undernourished and the effect of macronutrient supplementation: a systematic review and meta-analysis

    CONCLUSIONS: Mortality among non-severely undernourished children with pneumonia ranges between 1-13% globally. There is inadequate follow-up nutritional assessment and management for non-severely undernourished children with pneumonia.

32. Systematic review on the measurement properties of patient-reported outcome measures (PROMs) for measuring well-being in young children

    CONCLUSION: Few instruments to measure the well-being of children aged 2-7 years are available, and only three measurement properties were fully evaluated in these studies. This review was conducted even if there was incomplete or unavailable information regarding their content validity. Further research is recommended before these measures may be recommended for use.

33. QbTest for ADHD assessment and medication management: a mixed-methods systematic review of impact on clinical outcomes and patient, carer and clinician experiences

    CONCLUSIONS: The available evidence suggests the QbTest may be a useful addition to ADHD assessment in children and young people. Further well-designed RCTs with qualitative substudies are required to assess the impact of the QbTest on patient outcomes, user experience and cost, particularly for medication management and in adults, where evidence is scarce. Such RCTs should include economic analyses, direct comparisons to other continuous performance tests with motion trackers and subgroup...

34. Prevalence of unintended pregnancy in the MENA region: a systematic review and meta-analysis

    CONCLUSION: Our findings suggest that the MENA region faces a substantial burden of unintended pregnancies, with variations among countries and over time. The results emphasise the need for evidence-based interventions to address this issue, focusing on factors associated with unintended pregnancy.

35. Active group-based performing arts interventions in Parkinson's disease: an updated systematic review and meta-analysis

    CONCLUSIONS: Evidence from both the narrative synthesis and the meta-analysis supports a benefit for some combinations of performing arts modalities and outcomes. Limitations of the evidence base included differences in comparators and outcomes, heterogeneity, lack of control arms and male underrepresentation. Future studies should compare the effectiveness of different performing arts modalities, assess functional communication and consider clinical significance.

36. What are the experiences of people with heart failure regarding participation in physical activity? A systematic review, meta-aggregation and development of a logic model

    CONCLUSIONS: This study identifies behavioural determinants that underlie the actions of people with heart failure in their relationship with physical activity and potential intervention components for a novel intervention design to support this population. There is a lack of studies exploring health professionals' and carers' perspectives on this topic.

37. Alpha-lipoic acid on intermediate disease markers in overweight or obese adults: a systematic review and meta-analysis

    CONCLUSIONS: No significant associations were detected between ALA intake and intermediate disease markers, including TG, TC, HDL-C, LDL-C, HOMA-IR and FBS levels, in overweight or obese adults. Further research is needed to explore the potential associations of ALA, especially in high-risk populations with metabolic disorders, by employing longer intervention durations, higher dosages and optimised formulations.

38. Impact of COVID-19 infection on mortality, diabetic complications and haematological parameters in patients with diabetes mellitus: a systematic review and meta-analysis

    CONCLUSIONS: SARS-CoV-2 infection is associated with elevated risks of mortality and acute kidney injury and poor glycaemic control in PLWD, alongside increased levels of inflammatory and coagulation biomarkers. These findings underscore the urgent need for tailored clinical management strategies for PLWD with COVID-19.

39. Vitamin D supplementation for managing COVID-19 in patients with vitamin D deficiency: a systematic review and meta-analysis of randomised controlled trials

    CONCLUSION: Based on evidence of low to moderate quality, vitamin D supplementation reduced the mortality rate during follow-up in COVID-19 patients with vitamin D deficiency. However, it did not improve 28-day mortality, nor did it reduce the need for mechanical ventilation and ICU admission, or the length of stay in the ICU and hospital.

40. Research waste in randomised trials of exercise treatments for chronic low back pain: trial sequential and cumulative meta-analyses by publication date and size

    CONCLUSIONS: It may be difficult to justify any further trials comparing exercise interventions to usual care/no treatment for chronic low back pain. The inclusion of small studies in meta-analyses has produced biased results in previous meta-analyses. Exercise treatments might not have a clinically important effect on people with chronic low back pain.

41. Risk factors for delayed graft function in patients with kidney transplantation: a systematic review and meta-analysis

    CONCLUSION: This meta-analysis identified seven significant risk factors for DGF, including prolonged CIT, elevated donor end-stage serum creatinine, extended dialysis vintage, increased HLA mismatch number, higher donor BMI, advanced donor age and recipient diabetes mellitus. These findings may offer potential insights for developing clinical strategies to mitigate the risk of DGF in kidney transplant recipients and improve postoperative management.

42. Safety and effectiveness of multimodal opioid-free anaesthesia for pain and recovery after laparoscopic surgery: a systematic review and meta-analysis

    CONCLUSIONS: OFA may be more beneficial for postoperative pain management and recovery in patients undergoing laparoscopic surgery compared with conventional OA. Future studies could further extend these findings to other surgical populations.

43. Effectiveness and tolerance of exercise interventions for long COVID: a systematic review of randomised controlled trials

    CONCLUSION: Available evidence suggests that exercise interventions may be beneficial and tolerable among some people with long COVID. However, the evidence base consists of a limited number of studies with small sample sizes and short follow-up periods.

44. Healthcare professional perspective on barriers and facilitators of multidisciplinary team working in acute care setting: a systematic review and meta-synthesis

    CONCLUSIONS: This meta-synthesis identifies specific barriers and facilitators and variables that can act as both. Understanding these factors enables targeted interventions to enhance the performance of multidisciplinary teams in clinical practice, particularly in acute care settings.

45. Suicidal behaviours and associated factors among Bangladeshi medical students: a systematic review and meta-analysis (2000-2024)

    CONCLUSIONS: Suicidal behaviours particularly, suicidal ideation, are high among Bangladeshi medical students. However, very few studies were done in this country to quantify the burden and its associated factors.

46. Association of 15 common dietary factors with tinnitus: a systematic review and meta-analysis of observational studies

    CONCLUSIONS: This systematic review and meta-analysis suggest a link between particular dietary elements and a lower incidence of tinnitus.

47. Economic evaluations of sexual and reproductive health (SRH) services in low- and middle-income countries (LMICs): a systematic review

    CONCLUSIONS: The review revealed heterogeneity in approaches to evaluating the costs and outcomes of SRH programmes. These methodological limitations may have implications for their use by public health decision-makers to inform optimal decision-making.

48. Acceptability of digital health interventions in perioperative care: a systematic review and narrative synthesis of clinician perspectives

    CONCLUSIONS: Clinicians' acceptance of DHIs is primarily driven by perceived effectiveness. Optimism about the potential for DHIs to enhance care is often overshadowed by concerns about patient safety, privacy and opportunity costs. As clinicians are key gatekeepers in DHI adoption, these perspectives have a significant impact on the long-term integration of these technologies into perioperative care. Cocreation of DHIs with clinicians is required to address implementation barriers, enhancing...

49. Economic evaluations in undergraduate medical education: a systematic review

    CONCLUSIONS: Economic evaluations in UME are scarce and often of limited methodological rigour. A shift towards comprehensive, prospective evaluations is needed to address long-term outcomes, societal perspectives and methodological robustness. Such efforts will enable better resource allocation, enhance the impact of medical education and contribute to a sustainable educational landscape.

50. Diabetic foot self-care practices and its predictors among diabetes mellitus patients in Ethiopia: systematic review and meta-analysis

    CONCLUSIONS: The overall prevalence of good diabetic foot self-care practices among DM patients in Ethiopia is relatively high. Residence, sex and knowledge of foot care were identified as key predictors of effective foot self-care practices in this population. To enhance diabetic foot self-care in Ethiopia, it is crucial to strengthen education on foot care. Tailored interventions should be developed specifically for men and rural residents to improve their diabetic foot self-care practices.