Systematic Reviews最新文献

{"title":"Prevalence and risk factors of gross neurologic deficits in children after severe malaria: a systematic review protocol.","authors":"Allen Eva Okullo, Chandy C John, Richard Idro, Andrea L Conroy, Alison Annet Kinengyere, Kevin Ouma Ojiambo, Caroline Otike, Simple Ouma, Moses Ocan, Ekwaro A Obuku, Michael Boele van Hensbroek","doi":"10.1186/s13643-025-02785-4","DOIUrl":"10.1186/s13643-025-02785-4","url":null,"abstract":"<p><strong>Background: </strong>Children exposed to severe malaria may recover with gross neurologic deficits (GND). Several risk factors for GND after cerebral malaria (CM), the deadliest form of severe malaria, have been identified in children. However, there is inconsistency between previously reported and more recent findings. Although CM patients are the most likely group to develop GND, it is not clear if other forms of severe malaria (non-CM) may also contribute to malaria-related GND. The objective of this systematic review is to synthesize evidence on the prevalence and risk factors for GND in children after severe malaria.</p><p><strong>Methods: </strong>The systematic review will be conducted according to recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P). Relevant research articles will be identified using relevant search terms from the following databases: MEDLINE, Embase, Web of Science, and Global Index Medicus (GIM). The articles will be screened at title and abstract and then at full text for inclusion using a priori eligibility criteria. Data extraction will be carried out using a tool developed and optimized in an Excel spreadsheet. Risk of bias will be assessed using appropriate tools including Risk Of Bias In Non-randomized Studies of Exposures (ROBINS-E) and the Cochrane Risk of Bias 2.0 (ROB2) for randomized control trials (RCTs), and where appropriate, publication bias will be assessed using a funnel plot. A random-effects meta-analysis or synthesis without meta-analysis (SWiM) will be performed as appropriate, and the results will be presented in tables and graphs.</p><p><strong>Conclusion: </strong>Findings from this systematic review will inform policymakers on the planning, design, and implementation of interventions targeting the treatment and rehabilitation of GND following severe malaria in children.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42022297109.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"76"},"PeriodicalIF":6.3,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of exercise, nutrition, and combined exercise and nutritional interventions in older adults with sarcopenic obesity: a protocol for systematic review and network meta-analysis.","authors":"Youwen Gong, Yongqiang Yang, Xueqing Zhang, Li Tong","doi":"10.1186/s13643-025-02825-z","DOIUrl":"10.1186/s13643-025-02825-z","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenic obesity (SO) in older adults is associated with certain adverse outcomes, including falls, fractures, and disability, all of which affect patient quality of life, represent an economic burden, and potentially enhance the risk of death. Although a number studies have examined the effects of exercise, nutrition, and combined exercise and nutritional interventions on older adults with SO, the optimal therapeutic approach has yet to be sufficiently established. In this systematic review and network meta-analysis (NMA) protocol for SO in older adults, we aim to compare the combined effects of exercise and nutrition with those of exercise or nutritional interventions alone on the body composition and physical performance of older adults with SO.</p><p><strong>Methods: </strong>The PubMed, Web of Science, Embase, OVID, CINAHL, CNKI, Wanfang Data, and VIP databases will be used to systematically search for randomized controlled trials published from the time of database inception to December 2024. Outcomes will include body composition and physical performance, and data will be extracted independently by two researchers. In cases of disagreement, a consensus will be reached by consulting a third researcher. The Cochrane risk-of-bias tool will be used to assess randomized controlled trials, and data analysis will be performed using Stata 15.0 and R software, based on homogeneity, sensitivity, transitivity, consistency, and publication bias tests.</p><p><strong>Discussion: </strong>By comprehensively assessing the relative efficacies of exercise, nutrition, and combined interventions in older adults with SO, we aim in this systematic review and NMA to fill an important gap in the existing literature. These findings will provide a reference for healthcare providers and policymakers and facilitate the development of evidence-based guidelines that will contribute to optimizing SO management and gaining more favorable outcomes for this vulnerable population.</p><p><strong>Systematic review registration: </strong>CRD42024504706.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"77"},"PeriodicalIF":6.3,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of theta burst stimulation (TBS) on aphasia in stroke patients: a protocol of systematic review and meta-analysis.","authors":"Hong-Juan Fu, Yong Tang, Xin-Ru Wen, Wen-Qian Zhao, Yi-Qiu Gao, Chen Huang, Li-Hong Zeng, Shu-Hao Zhang, Juan Li, Guan-Chao Zuo","doi":"10.1186/s13643-025-02823-1","DOIUrl":"10.1186/s13643-025-02823-1","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have 3suggested that theta burst stimulation (TBS) may be a promising intervention for the rehabilitation of aphasia after stroke. However, the results of these investigations have been inconsistent, with no definitive consensus on its efficacy and safety. Given the inconclusive nature of the existing evidence, this study aims to conduct a comprehensive and systematic review to evaluate the therapeutic effects of TBS on aphasia in stroke patients.</p><p><strong>Methods: </strong>We will perform an extensive search of eight online databases from their inception to August 1, 2024, to identify relevant randomized controlled trials (RCTs) that examine the impact of TBS on aphasia in stroke patients. The primary outcome will be the severity of aphasia, assessed using a suite of standardized evaluation tools. Secondary outcomes will include measures of naming, repetition, comprehension, spontaneous speech, aphasia quotient, quality of life, and documentation of adverse events. The review process will involve rigorous study selection, data extraction, risk of bias assessment, and evaluation of the certainty of evidence by two independent reviewers. Data synthesis and statistical analysis will be conducted using Review Manager (RevMan) software, version 5.3. If significant heterogeneity is not detected among the studies, a meta-analysis will be performed. Otherwise, a narrative qualitative summary will be provided. The quality of evidence will be assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system.</p><p><strong>Discussion: </strong>This study will be the first systematic review to comprehensively synthesize the existing evidence regarding the application of TBS in the treatment of aphasia in stroke patients. The findings are expected to provide valuable insights for clinicians and policymakers, facilitating the development of more equitable and high-quality healthcare services for this patient population.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42024521347.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"75"},"PeriodicalIF":6.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The waterpipe smoking and human health: a systematic review and meta-analysis of 191 observational studies.","authors":"Mahdi Sepidarkish, Shima Rezazadeh, Helia Ghaffari Hamedani, Fatemeh Lohrasbi, Sadaf Abdi, Zahra Mohammadi-Pirouz, Fatemeh Ghavam, Wasim Maziak","doi":"10.1186/s13643-025-02799-y","DOIUrl":"10.1186/s13643-025-02799-y","url":null,"abstract":"<p><strong>Background: </strong>While growing evidence highlights the harmful effects of waterpipe smoking (WPS), detailed information about its association to chronic diseases remains limited. This systematic review and meta-analysis exploring the association between WPS and various health conditions.</p><p><strong>Methods: </strong>A systematic search of MEDLINE (via PubMed), Embase, Scopus, and Web of Science was conducted from inception to January 2025. Eligible observational studies on WPS and health outcomes were selected through a duplicate, independent process. Data extraction, including study details, participant characteristics, methods, and results, was performed independently by two reviewers using a standardized form. Methodological quality was assessed using the Newcastle-Ottawa scale (NOS), and studies were classified as high, moderate, or poor quality. The GRADE approach was applied to evaluate evidence certainty for each outcome, considering factors such as study design, risk of bias, consistency, precision, and publication bias.</p><p><strong>Results: </strong>A total of 191 studies with 807,174 participants were included, comprising 98 case-control, 77 cross-sectional, and 16 cohort studies from 24 countries. The median number of studies analyzed per outcome was 5, with a range of 3 to 30. Among the 62 outcomes evaluated, 31 (50%) demonstrated statistically significant effect sizes based on a random-effects model, with stroke, coronary artery disease (CAD), and cancer mortality exhibiting a significant prediction interval. Credibility evaluations identified low-quality evidence for birth weight, CAD, and cardiovascular and cancer mortality, whereas the evidence for the remaining outcomes was graded as very low quality. Significant associations were found between WPS and several health outcomes: gastric cancer, lung cancer, bladder cancer, esophageal cancer, CAD, stroke, diabetes, metabolic syndrome, overall mortality, cardiovascular mortality, cancer mortality, infertility, sperm normal form, sperm DNA fragmentation, chronic bronchitis, cough, sputum, low birth weight (LBW), spirometry parameters, and several dental health indicators.</p><p><strong>Conclusion: </strong>This study reveals strong links between WPS and adverse health outcomes, but low evidence quality calls for rigorous research and public health interventions to mitigate its effects.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"74"},"PeriodicalIF":6.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WHO Framework Convention on Tobacco Control Articles 9 and 10 implementation for sustainable tobacco control-a scoping review protocol.","authors":"Sonu Goel, Diksha Walia, Priyobrat Rajkhowa, Chirag Goel","doi":"10.1186/s13643-025-02822-2","DOIUrl":"10.1186/s13643-025-02822-2","url":null,"abstract":"<p><strong>Introduction: </strong>Tobacco consumption continues to pose a substantial global public health threat, resulting in more than 8 million preventable deaths annually. The WHO Framework Convention on Tobacco Control (FCTC) negotiated as the first global public health treaty under the auspices of the WHO, which serves as a critical instrument in combating the global tobacco epidemic. The WHO FCTC prioritizes a comprehensive approach that addresses both the demand for and supply side interventions for curbing tobacco epidemic globally. Strong evidence demonstrates the efficacy of these measures in safeguarding individuals, regardless of age, from tobacco initiation, and the associated harms. WHO FCTC Article 9 and 10 emphasizes upon testing and disclosure of tobacco product contents. This scoping review aims to explore the Implementation Landscape of WHO FCTC Articles 9 and 10 globally by adopting Consolidated Framework for Implementation Research (CFIR) framework.</p><p><strong>Methods: </strong>The planned scoping review will adhere to the methodology outlined by \"Arksey and O'Malley and Levac et al.\" Through an exhaustive search strategy, relevant literature published from 2013 onwards will be sourced from databases including PubMed, CINAHL, EMBASE, Web of Science, Scopus, government websites, and reports. A predetermined set of criteria for study inclusion and exclusion will be applied independently by four reviewers to assess study eligibility. The findings will be synthesized narratively and qualitatively analyzed, incorporating the Consolidated Framework for Implementation Research (CFIR) framework for discussion and outlining. The review will adhere to the reporting standards outlined in the \"Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Review (PRISMA-ScR)\" guidelines.</p><p><strong>Conclusions/discussion: </strong>Analyzing the implementation of FCTC Articles 9 and 10 across global contexts is expected to offer valuable insights into the need for context-specific adjustments and customized interventions. Understanding regional variations in efforts to regulate tobacco products is crucial for formulating specific strategies that effectively address cultural, economic, and regulatory challenges. This comparative examination has the potential to guide policymakers, public health professionals, and researchers in optimizing tobacco control initiatives to expedite progress toward effective implementation of Articles 9 and 10 in both the WHO-SEAR region and globally.</p><p><strong>Ethics approval: </strong>This review will identify the landscape of the implementation of WHO FCTC Article 9 and 10. This review will also identify the best practices, policies, and strategies across the globe. An ethics committee approval was not sought for this since this involve secondary data.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"73"},"PeriodicalIF":6.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Empirical comparisons of heterogeneity magnitudes of the risk difference, relative risk, and odds ratio\".","authors":"Hirotaka Mori","doi":"10.1186/s13643-025-02758-7","DOIUrl":"10.1186/s13643-025-02758-7","url":null,"abstract":"","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"71"},"PeriodicalIF":6.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Reiki therapy on quality of life: a meta-analysis of randomized controlled trials.","authors":"Kuiliang Liu, Zhikai Qin, Yizhen Qin, Yanfeng Li, Qing Liu, Fei Gao, Pengrui Zhang, Wei Wang","doi":"10.1186/s13643-025-02811-5","DOIUrl":"10.1186/s13643-025-02811-5","url":null,"abstract":"<p><strong>Purpose: </strong>This review aimed to evaluate the therapeutic effects of Reiki therapy on quality of life.</p><p><strong>Methods: </strong>The review followed standard scientific journal practices and a systematic search of PubMed, Web of Science, Embase, Scopus, and the Cochrane Library, with a literature cutoff of September 2024, was conducted to identify relevant studies. Inclusion criteria comprised articles published in English, randomized controlled trials (RCT), Reiki therapy as the independent variable, diverse patient populations, and outcome measures focusing on quality of life improvement.</p><p><strong>Results: </strong>The review involved 661 participants aged 14 years and above, showing a significant enhancement in quality of life post-Reiki therapy (SMD = 0.28, 95% CI 0.01 ~ 0.56, P = 0.043). The subgroup analysis showed that Reiki therapy interventions with a frequency of ≥ 8 sessions and a duration of ≥ 60 min and acute interventions of ≤ 20 min were most effective in improving quality of life.</p><p><strong>Conclusions: </strong>The existing meta-analysis and systematic review suggested that Reiki therapy positively impacted quality of life. Therefore, it was recommended that patients with cancer, surgical patients, chronic illnesses, and the general population receive acute Reiki therapy sessions (≤ 20 min) or Reiki therapy with sufficient frequency (≥ 8 sessions) and duration (≥ 60 min) to enhance their quality of life.</p><p><strong>Systematic review registration: </strong>Systematic review registration: PROSPERO CRD 42023483961.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"72"},"PeriodicalIF":6.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of lower limb rehabilitation robot on lower limb -motor function in stroke patients: a systematic review and meta-analysis.","authors":"Qing-Hong Hao, Mi-Mi Qiu, Jun Wang, Yang Tu, Zhi-Hai Lv, Tian-Min Zhu","doi":"10.1186/s13643-025-02759-6","DOIUrl":"10.1186/s13643-025-02759-6","url":null,"abstract":"<p><strong>Background: </strong>The assessment and enhancement of lower limb motor function in hemiplegic patients is of paramount importance. The emergence of lower limb rehabilitation robots offers a promising avenue for improving motor function in these patients, addressing the limitations associated with traditional rehabilitation therapies. However, a consensus regarding their clinical effectiveness remains elusive. Consequently, the objective of this study is to systematically review the rehabilitation efficacy of lower limb rehabilitation robots on motor function in post-stroke hemiplegic patients, thereby providing robust clinical evidence to support their promotion and utilization.</p><p><strong>Methods: </strong>Eight databases were examined between the start and April 2024. Patients with hemiplegia were included in randomized controlled trials to examine the effects of a lower limb rehabilitation robot on their motor function. Data extraction, risk of bias assessment, and study screening were carried out independently by two reviewers. Stata and Review Manager 5.3 were used for the meta-analysis. Sensitivity analysis was used to determine how reliable the findings were. To examine the origins of heterogeneity, meta-regression and subgroup analysis were employed.</p><p><strong>Results: </strong>This review comprised a total of 41 studies with 3279 participants. In one or more domains, the majority of the studies were rated as having a low or uncertain risk of bias. The study's findings demonstrated that the lower limb walking function, balance function, and ability to do activities of daily living improved more in the group receiving conventional rehabilitation (CR) + robot-assisted therapy (RT) than in the CR group. The Berg Balance Scale (BBS), which measures balance function, and the Fugl-Meyer scale (FMA), which measures lower limb motor function, were both better in the RT group than in the CR group. Sensitivity analysis proved that the findings were reliable. The sample size and publication years were found to be somewhat responsible for the heterogeneity, according to meta-regression analysis and subgroup analysis.</p><p><strong>Conclusion: </strong>In stroke patients with hemiplegia, the lower limb rehabilitation robot has demonstrated a certain level of clinical success in regaining lower limb function.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"70"},"PeriodicalIF":6.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of Chinese patent medicines for allergic rhinitis based on 2020 Chinese Pharmacopoeia: a protocol for systematic review and meta-analysis of randomized controlled trials.","authors":"Weibo Zhao, Lingyao Kong, Xuehui Wang, Qingyuan Liu, Yaqi Wang, Ji Wang","doi":"10.1186/s13643-024-02748-1","DOIUrl":"10.1186/s13643-024-02748-1","url":null,"abstract":"<p><strong>Background: </strong>Allergic Rhinitis (AR) is a prevalent chronic respiratory condition with limited long-term relief from Western medications. Interest in Traditional Chinese Patent Medicines (TCPMs) as a complementary approach is growing, but research on their efficacy and safety is lacking. We aim to evaluate the efficacy and safety of TCPMs listed in the 2020 Chinese Pharmacopoeia (ChP 2020) that are indicated for treating AR.</p><p><strong>Methods: </strong>We will search PubMed, Embase, Web of Science, Cochrane Library, and four Chinese databases to retrieve randomized controlled trials investigating specific TCPMs (Biyankang tablets, Tongqiao Biyan Granules, Tongqiao Biyan Tablets, Tongqiao Biyan Capsules, Xinqin Granules, Xinqin Tablets, Xinyi Biyan Pills) for AR. Primary outcomes are Total Nasal Symptom Scores (TNSS) and Total Ocular Symptom Scores (TOSS). Secondary outcomes include quality of life, relapse rates, nasal function, biomarkers, and adverse events. No languages and publication data limitations. Meta-analysis will be performed using RevMan 5.4 with random effects model. Publication bias are set to be assessed using funnel plots and Egger's test, and adjusted with the trim and fill method. Meta-regression will investigate factors influencing outcomes for AR. Study quality will be assessed using the Cochrane Risk of Bias 2.0 tool, and the Grading of Recommendations Assessment, Development, and Evaluation approach will be used to evaluate the quality of evidence.</p><p><strong>Discussion: </strong>Despite the limitations of conventional AR medications, TCPMs show potential benefits in immune modulation and symptom relief. This review will focus on TCPMs listed in ChP 2020 to comprehensively evaluate their safety and efficacy for AR. Unlike existing reviews, this study emphasizes rigorous standards of TCPMs, aiming to provide a more reliable evidence base. Although a network meta-analysis would be ideal, a traditional meta-analysis will be conducted due to limited data. Future research should focus on direct comparative studies and utilize AI techniques for understanding mechanisms and enhancing personalized treatments. This review aims to bridge gaps in the current literature and potentially improve clinical guidelines and patient outcomes in AR management.</p><p><strong>Systematic review registration: </strong>INPLASY202450121.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"69"},"PeriodicalIF":6.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of esketamine in preventing perioperative neurocognitive disorders: a meta-analysis of randomized controlled studies.","authors":"Kuo-Chuan Hung, Chia-Li Kao, Chun-Ning Ho, Jheng-Yan Wu, Ying-Jen Chang, Chien-Ming Lin, I-Wen Chen","doi":"10.1186/s13643-025-02807-1","DOIUrl":"10.1186/s13643-025-02807-1","url":null,"abstract":"<p><strong>Background: </strong>Perioperative neurocognitive disorders (POND) are common in older adults and are associated with adverse outcomes. This meta-analysis aimed to evaluate the efficacy and safety of esketamine for the prophylaxis of POND.</p><p><strong>Methods: </strong>Electronic databases were comprehensively searched from inception to April 1, 2024, to identify randomized controlled trials (RCTs) exploring the impact of perioperative esketamine on POND in adult patients. The primary outcomes were the incidence of POND and the level of postoperative cognitive function. The secondary outcomes included recovery characteristics (i.e., respiratory depression, extubation time, agitation, hallucinations, and nightmares) and inflammatory markers. Subgroup and meta-regression analyses were conducted to investigate the heterogeneity and effect of esketamine dosage.</p><p><strong>Results: </strong>A total of 24 RCTs (n = 2,130 patients), all conducted in China with relatively short follow-up periods (≤ 3 months), were included. Esketamine was found to significantly reduce the risk of POND (risk ratio:0.53, 95%confidence interval [CI]: 0.43-0.67) and improved cognitive function on postoperative day 1 (standardized mean difference [SMD]:1.22, 95%CI:0.85-1.59) and day 3 (SMD:0.94, 95%CI: 0.46-1.43) compared with controls, without impacting recovery characteristics. Furthermore, esketamine was associated with lower pain scores, reduced risk of postoperative nausea/vomiting, and decreased levels of inflammatory markers (IL-6, TNF-α, and S100β). Subgroup and meta-regression analyses revealed that age, quality of studies, type of esketamine administration, and esketamine dosage did not have a significant impact on cognitive outcomes. The evidence showed moderate certainty for POND risk, low certainty for POD 1 cognitive function and several complications (agitation, hallucinations, PONV, respiratory issues, nightmares) and biomarkers (TNF-α, s100β), and very low certainty for POD 3 cognition, extubation time, pain, and IL-6 levels.</p><p><strong>Conclusion: </strong>Perioperative esketamine is potentially effective in reducing the risk of POND and improving cognitive function in adult patients, regardless of age and dosage. Nevertheless, the certainty of evidence was low to very low for several outcomes (e.g., cognitive function on POD 3). Given that all included studies were conducted in China with relatively short follow-up periods, further high-quality RCTs with diverse populations and longer follow-up are warranted to validate these findings.</p>","PeriodicalId":22162,"journal":{"name":"Systematic Reviews","volume":"14 1","pages":"68"},"PeriodicalIF":6.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}