BMJ Open

1. 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.

2. 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.

3. 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...

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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...

19. 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.

20. 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.

21. Sex bias consideration in healthcare machine-learning research: a systematic review in rheumatoid arthritis

    CONCLUSIONS: The findings demonstrate the need for increased promotion of inclusive and equitable ML practices in healthcare to address unchecked sex bias in ML algorithms.

22. Barriers to conversations about deceased organ donation among adults living in the UK: a systematic review with narrative synthesis

    CONCLUSION: Conversations about death and organ donation are often brief and hindered by cultural taboos surrounding death, generational differences in attitudes and the influence of family dynamics. Further research is needed to understand communication patterns better and to tailor interventions that encourage open discussions about organ donation across different ethnic groups.

23. Research quality and dissemination of paediatric randomised controlled trials with and without patient and family engagement: systematic review

    CONCLUSIONS: Despite increasing interest in patient and family engagement in child health research, this review showed that few paediatric RCTs report patient engagement activity. Research quality was similar for trials engaging patients and families compared with those that did not. Patient and family engagement in the trial, however, was associated with higher metrics for social media attention, compared with trials with no engagement.

24. Outcome measurement for gender-affirming care in Canada: a systematic review

    CONCLUSION: This review reveals gaps in outcome measurement for GAC, particularly underutilisation of PROMs and inconsistent outcome measurement and reporting. There is a need to systematically implement PROMs, including those measuring gender-related constructs, to promote patient-centred care. This review provides evidence-based recommendations for improving health outcomes for TGD individuals in Canada.

25. Access and use of general and mental health services before and during the COVID-19 pandemic: a systematic review and meta-analysis

    CONCLUSION: By considering MH, our study provides consolidated evidence and quantifies the reduction in the use of health services during the COVID-19 pandemic.

26. Factors associated with prehospital and in-hospital delays in acute ischaemic stroke care in Indonesia: a systematic review

    CONCLUSION: Socioeconomic, cultural, clinical severity and logistical factors were significantly associated with hospital delays in acute ischaemic stroke care in Indonesia. Targeted interventions can mitigate these challenges and improve stroke management and results.

27. Effects of water aerobics on body composition in obesity and overweight people: a systematic review and meta-analysis

    CONCLUSION: For the obesity and overweight people, WAs interventions over 10 weeks (ie, 12 weeks) reduced BW and WC, with more significant effects in women and greater improvements in body composition in middle-aged and older adults (average age ≥45 years). The moderate certainty of evidence for BW and WC, as assessed using the GRADE framework, indicates that these findings are robust.

28. Healthcare workers' perspectives on barriers and facilitators to referral to type 2 diabetes prevention programmes: a systematic review

    CONCLUSIONS: Future strategies to improve referral to DPPs should include clear referral pathways and the resourcing of referral. Strategies are also needed to build awareness of DPPs and to address concerns among HCWs about their patients.

29. Prevalence and risk factors of persistent cough in patients diagnosed with renal cell carcinoma: a systematic review and meta-analysis

    CONCLUSION: Cough can occur in patients with RCC, as part of the disease pathogenesis, as an adverse effect of systemic treatment or due to unrelated causes such as pre-existing conditions (eg, asthma). Further research is required to determine the true prevalence and cause and to assess whether cough could be a presenting symptom for RCC.

30. Risk prediction models for dental caries in children and adolescents: a systematic review and meta-analysis

    CONCLUSIONS: Simplified predictive models for childhood caries showed moderate discriminatory performance but exhibited a high risk of bias, as assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Future research should adhere to PROBAST guidelines to minimise bias risk, focus on enhancing model quality, employ rigorous study designs and prioritise external validation to ensure reliable and generalisable clinical predictions.

31. Accuracy of individual signs and symptoms and case definitions for the diagnosis of influenza in different age groups: a systematic review with meta-analysis

    CONCLUSIONS: Individual signs and symptoms, their combinations, and ILI case definitions have very limited accuracy for identifying persons with influenza. More accurate surveillance and diagnosis will require the development and validation of accurate risk scores or greater use of point-of-care testing.

32. Accuracy of machine learning and traditional statistical models in the prediction of postpartum haemorrhage: a systematic review

    CONCLUSIONS: ML models are promising for predicting PPH. Nevertheless, they often require a large number of predictors, which may limit their applicability or necessitate automation through digital systems. This poses challenges in resource-scarce settings where the majority of PPH complications occur.

33. Health literacy of primary caregivers of children with cerebral palsy in low- and middle-income countries: a systematic review

    CONCLUSIONS: This study presents the first comprehensive analysis of health literacy among PCGs of children with CP in LMICs. Findings reveal a striking absence of tailored health literacy literature, impacting current considerations of PCGs' understanding and management of their child's condition. Additionally, challenges in social support, healthcare navigation and low literacy levels further hinder effective caregiving in LMICs.

34. Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis

    CONCLUSIONS: As add-on therapy, SGLT2is demonstrated favourable antidiabetic efficacy and acceptable safety. 300 mg of canagliflozin was the best option among the included interventions considering favourable glucose control and WL. Some novel SGLT2is (eg, henagliflozin) exhibited promising efficacy and safety profiles, but more research is needed to validate the findings.

35. Scoping review for pain mitigation during intralesional injections of corticosteroid for hypertrophic scar and keloid treatment

    CONCLUSION: Pain can significantly impact patient compliance and treatment outcomes. This review offers a foundational reference for healthcare providers and researchers in the field of scar management, providing insights into current practices and highlighting areas for future research and development.

36. Efficacy and safety of balneotherapy in rheumatology: a systematic review and meta-analysis

    CONCLUSION: The certainty of the effect of balneotherapy in rheumatology was very low.

37. Effectiveness of SMS-based interventions in enhancing antenatal care in developing countries: a systematic review

    CONCLUSION: SMS-based interventions have the potential to enhance ANC in LMICs by providing tailored health information and promoting healthy behaviours. Further research should focus on refining or replicating these interventions and exploring their long-term effects on maternal and child health outcomes, particularly in underrepresented regions.

38. Role of informal carers in medication management for people with long-term conditions: a systematic review

    CONCLUSION: Informal carers undertake a wide variety of medication-related activities. The studies emphasised the need to support families as partners in health outcomes. This systematic review identifies the importance of bridging the gap between carers and healthcare providers. More efforts are needed to empower carers towards better and safer caregiving. Future work could address how to optimise carer involvement and engagement and provide best practice recommendations for carers' support.

39. Accuracy of machine learning methods in predicting prognosis of patients with psychotic spectrum disorders: a systematic review

    CONCLUSION: Machine learning methods show promise in the prediction of prognosis (specifically functioning, relapse and remission) of mental disorders based on relevant collected variables. Future machine learning studies may want to focus on the inclusion of a broader swathe of variables including ecological momentary assessments, with a greater amount of good quality big data covering longer longitudinal illness courses and coupled with external validation of study findings.

40. Medication adherence of patients with peripheral arterial disease to antithrombotic therapy: a systematic review

    CONCLUSION: Heterogeneous study designs create a wide dispersion in the proportions. However, poor MA to ATT was found in approximately one-third of the patients with PAD and seemed to increase with longer therapy duration, which highlights the magnitude of this societal challenge. Enhancing patients' MA to ATT might be a key element in reducing the risk of AE, and therefore, more attention to MA in clinical and research settings is warranted.

41. Comparative effectiveness and safety of nifedipine and magnesium sulfate as treatment options for preterm birth: a systematic review and meta-analysis

    CONCLUSION: Compared with magnesium sulfate, nifedipine is more effective with a faster onset of action and a longer prolonging pregnancy. Additionally, nifedipine may be safer for fewer maternal side effects and better neonatal outcomes. Further studies are needed to confirm the long-term safety and efficacy of these treatments.

42. Effectiveness of clinical healthcare interventions for enhancing the work participation of patients with various health conditions: a synthesis of systematic reviews

    CONCLUSIONS: There is considerable overlap in clinical healthcare interventions that aim to enhance work participation for patients across health conditions. Although their effects on work participation vary, some conditions show favourable response to multidisciplinary interventions. More evidence is needed on developing tailored interventions and evaluating their cost-effectiveness.

43. Health impacts of the Sure Start programme on disadvantaged children in the UK: a systematic review

    CONCLUSION: This study examines the evidence of the Sure Start programme, as an example of an early-years community-based intervention, to mitigate health inequity among disadvantaged children. The findings suggest the Sure Start programme to be effective in health generation across the domains of physical health and neurodevelopmental disorders for disadvantaged children, but with mixed findings for social development that can only partially be explained by methodological flaws.

44. Satisfaction with HIV/AIDS treatment and care services and its associated factors among adult people receiving antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

    CONCLUSIONS: More than two-thirds were satisfied with HIV/AIDS treatment and care services in Ethiopia. The findings showed the presence of regional differences in satisfaction with HIV/AIDS treatment and care services. The finding suggested that policy-makers and healthcare administrators should focus on empowering patients to make treatment decisions, pay attention to areas of service provision that affect HIV/AIDS care and treatment services and make strategic plans for effective and...

45. Effect of statins on neurological functional outcomes in critically ill adult patients with traumatic brain injury: a systematic review and meta-analysis

    CONCLUSION: We found no conclusive evidence supporting the use of statins in critically ill adult patients with TBI at this time. Nevertheless, the trials were limited, and wide confidence intervals resulted in significant uncertainty of the findings. A potential benefit cannot be ruled out, underscoring the need for a larger, well-designed trial.

46. Implementation of decarbonisation actions in general practice: a systematic review and narrative synthesis

    CONCLUSIONS: There is limited evidence on the implementation of decarbonisation actions in general practice. A range of factors may impact on the extent to which implementation occurs. Addressing these will be crucial for effectively promoting and scaling decarbonisation actions in general practice. Future research should focus on understanding the role of institutional context, evaluating the real-world impact of interventions on greenhouse gas emissions and exploring patient and community...

47. Coproducing a culturally sensitive storytelling video intervention to improve psychosocial well-being: a multimethods participatory study with Nepalese migrant workers

    CONCLUSIONS: This is a feasibility study conducted in a single district of Nepal; as such, the findings should be generalised cautiously. Despite these limitations, the project is testament to the value of participatory methods in the development of culturally sensitive public health interventions for marginalised groups, and points to the utility of coproduced storytelling formats in migrant health contexts. Future research is needed to evaluate feasibility and acceptability of the intervention...

48. Inhaled methoxyflurane (Penthrox) use in the outpatient and ambulatory setting: a systematic review

    CONCLUSION: Penthrox (methoxyflurane) shows promise as an analgesic for invasive, elective interventional procedures in the outpatient setting, although the relative benefits appear to vary depending on intervention and comparator pain control measures. There is a pressing need for robustly conducted, large, generalisable multicentre RCTs to evaluate the effectiveness of Penthrox.

49. Association between Geriatric Nutritional Risk Index and survival outcomes in patients with urological cancers: an updated meta-analysis

    CONCLUSIONS: A low GNRI is significantly associated with poor survival outcomes in patients with urological cancer. The GNRI may serve as a valuable prognostic tool in clinical practice. Further research is needed to validate these findings in diverse populations and to explore the underlying biological mechanisms.

50. Effect of restrictive fluid resuscitation on severe acute kidney injury in septic shock: a systematic review and meta-analysis

    CONCLUSIONS: It is conclusive that fluid restriction strategy is superior to usual care when it comes to reducing the incidence of severe AKI in sepsis-associated hypotension and shock. Shorter duration of ventilation is concerned with fluid restriction as well, but the heterogeneity is substantial. GRADE assessments confirmed moderate and above certainty. Traditional fluid resuscitation therapy has the potential to be further explored for improvements to be more precise and appropriate for a...