OBJECTIVE: The associated damage to articular cartilage in anterior cruciate ligament (ACL) injured patients is a well-recognized phenomenon; however, there is a relative paucity in the literature regarding the different treatment techniques and outcomes. The purpose of this systematic review was to identify patients treated for acute ACL rupture and associated cartilage injury, with interest in the surgical management of these chondral injuries and any difference in patient-reported outcome measures (PROMs) differing techniques.
METHODS: A systematic review was performed looking for treatment or management of International Cartilage Repair Society grade 3 or 4 articular cartilage injury at the time of ACL reconstruction.
RESULTS: Seventeen studies fit the criteria, a total of 892 patients were included, 64.6% were male with a mean age of 33.7 and the average time to follow-up was 41.7 months. 68.2% of the lesions were on the medial femoral condyle (MFC) with a mean lesion size of 3.9 cm2. Six different operative methods of dealing with chondral lesions were identified, there was no significant difference in PROMs between the techniques, although there was a significant difference between the preoperative and postoperative outcome measures.
CONCLUSIONS: The systematic review found that chondral defects on the MFC are more common in concomitant ACL injuries, despite the pattern of bone bruising being more common on the lateral femoral condyle as reported in the literature. It also found no significant difference in the PROMs between the six different techniques identified for the concomitant management of ACL reconstruction and chondral defects.
METHODS: Level II.

OBJECTIVE: Frailty and hypoproteinaemia are common in older individuals. Although there is evidence of a correlation between frailty and hypoproteinaemia, the relationship between frailty and hypoproteinaemia in hospitalized/critically ill and older community residents has not been clarified. Therefore, the aim of our meta-analysis was to evaluate the associations between frailty and hypoproteinaemia in different types of patients.
METHODS: A systematic retrieval of articles published in the PubMed, Embase, Medline, Web of Science, Cochrane, Wanfang, and CNKI databases from their establishment to April 2024 was performed to search for studies on the associations between severity of frailty or prefrailty and hypoproteinaemia in older adults. The Newcastle‒Ottawa Scale and the Agency for Healthcare Research and Quality Scale were used to assess study quality.
RESULTS: Twenty-two studies were included including 90,351 frail older people were included. Meta-analysis revealed an association between frailty or prefrailty and hypoproteinaemia (OR = 2.37, 95% CI: 1.47, 3.83; OR = 1.62, 95% CI: 1.23, 2.15), there was no significant difference in the risk of hypoproteinaemia between patients with severe frailty and those with low or moderate frailty (OR = 0.62, 95% CI:0.44, 0.87). The effect of frailty on the occurrence of hypoproteinaemia was more obvious in hospitalized patients/critically ill patients than in surgical patients (OR = 3.75, 95% CI: 2.36, 5.96), followed by older community residents (OR = 2.30, 95% CI: 1.18, 4.49).
CONCLUSIONS: Frailty is associated with hypoproteinaemia in surgical patients, hospitalized older patients and older community residents. Future studies should focus on the benefits of albumin supplementation in preventing or alleviating frailty and related outcomes in the future.

BACKGROUND: Economic sanctions are defined as restrictions imposed by other countries against individuals, groups, or governments of other countries. These sanctions have a detrimental impact on the economies of countries and can also limit access to healthcare services for people as a secondary consequence. This study aims to systematically review the literature to examine the direct and indirect effects of economic sanctions on health through a narrative synthesis.
METHODS: This systematic literature review was limited to papers published between January 1990 and July 2023. Relevant documents published in English and Persian were searched for in databases including Cochrane Library, PubMed, Embase, Scopus, Web of Science, SID, Magiran, and Irandoc. The direct and indirect effects of sanctions on health were classified using two frameworks proposed by the World Health Organization (WHO): the Health System Building Blocks and \"Social Determinants of Health\".
RESULTS: Out of a total of 18,219 articles, 59 were selected based on inclusion criteria. The effects of sanctions were divided into direct and indirect groups. Direct effects encompassed seven main themes: access to essential medicine, medical products, vaccines and technologies; financing; health workforce; service delivery; research and health information systems; health outcomes; and financial risk protection. Indirect effects also were classified into six main themes: socioeconomic status; food and agricultural products; stress; early life conditions; high-risk behaviors and addiction; and transport. Most studies focused on the access to medicines, food, economic and social status.
CONCLUSIONS: Economic sanctions have had profoundly negative impacts on all aspects of the healthcare system. The international community must address these effects on health and take necessary measures to prevent or mitigate them, particularly in ensuring the provision of basic and essential healthcare needs for individuals and communities.

OBJECTIVE: We sought to characterize and evaluate the effectiveness of pharmacist-led AMS interventions in improving antimicrobial use and subsequent surgical site infections (SSI) in perioperative settings.
METHODS: A systematic review and meta-analysis was conducted by searching PubMed, Embase and CINAHL. Two independent reviewers extracted the data using the Descriptive Elements of Pharmacist Intervention Characterization Tool and undertook quality assessment using the Crowe Critical Appraisal. A meta-analysis was conducted using a random-effect model.
RESULTS: Eleven studies were included in this review. Pharmacists were found to have various roles in AMS, including educational sessions, ward rounds, audits and feedback, and guidelines development. The discussion of interventions lacked details on the development. A meta-analysis revealed that pharmacist-led AMS programs in perioperative settings was associated with a significant improvement in antibiotic selection (OR 4.29; 95 % CI 2.52-7.30), administration time (OR 4.93; 95 % CI 2.05-11.84), duration (OR 5.27; 95 % CI 1.58-17.55), and SSI (OR 0.51; 95 % CI 0.34-0.77).
CONCLUSIONS: Pharmacist-led AMS programs were effective in improving antimicrobial prescribing while reducing SSI; however most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions, therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. High-quality, multicomponent, theory-derived, interventional studies using appropriate methodology and standardized data collection, are needed.

BACKGROUND: Due to the COVID-19 outbreak, schools had to switch online. As universities ease face-to-face (F2F) schooling, blended teaching and learning (BTL) enables the continuous delivery of education. However, the sudden transition to BTL poses challenges for students and teachers, especially for health sciences programmes that require hands-on practical experience. Several studies have evaluated F2F teaching and learning contexts through student feedback and evaluations. However, there needs to be more reliable and valid self-report questionnaires that focus on the perceptions and experiences of students experiencing BTL. This study will critically appraise, compare and summarise the quality of self-report questionnaires evaluating BTL among health science university students based on their psychometric properties.
METHODS: A systematic review and meta-analysis design will be used. This review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols and follow the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standardised guidelines. 13 databases will be searched for studies reporting BTL self-report questionnaires as evaluation tools with their respective psychometric properties. Two independent reviewers will appraise the paper using the COSMIN risk of bias checklist and the quality of evidence of the psychometric properties of the relevant questionnaires will be assessed using the modified Grading of Recommendations Assessment, Development and Evaluation approach. Based on their psychometric properties, these assessments will comprehensively summarise and present the best recommendations for the most appropriate self-report questionnaires for BTL evaluation.
BACKGROUND: The University of the Philippines\' Research Grants Administration Office exempted this research protocol from ethics review evaluation (protocol number UPMREB 2022-0259-EX) since this study will not collect individual data. The research protocol was registered with PROSPERO. The results will be disseminated through peer-reviewed journals and conferences to aid researchers and professionals in the field of health education to prudently choose effective self-report questionnaires evaluating blended learning.CRD42022372362.

BACKGROUND: Avoiding patient-prosthesis mismatch (PPM) in patients with small aortic annulus (SAA) during aortic valve replacement (AVR) is still a challenging surgical problem. Among surgical options available, aortic root enlargement (ARE) and stentless valve implantation (SVI) are the two most commonly used strategies. This systematic review will be conducted searching for superiority evidence based on comparative studies between these two options.
METHODS: This systematic review will include all relevant articles published from 1 January 1946 to 31 March 2024, with available full texts from Medline (Ovid), Embase, Cochrane Library and Web of Science databases, without any language restriction. Observational studies and randomised controlled trials comparing surgical results of ARE versus SVI for AVR in patients with small aortic root will be screened. Studies will be classified into three groups: group 1 for studies that reported SVI or other tissue valve outcomes without comparing them with ARE outcomes; group 2 for studies that reported ARE outcomes without comparing them with SVI outcomes; and group 3 for studies that compared ARE outcomes with SVI outcomes. The quality of the evidence of each study will be evaluated according to Oxford Centre for Evidence-Based Medicine criteria.
BACKGROUND: Ethical approval is not required because no primary data are collected. The findings will be presented at scientific conferences and/or reported in a peer-reviewed scientific journal.
BACKGROUND: PROSPERO, CRD42023383793.

BACKGROUND: The early detection of pancreatic cancer is an important step in reducing mortality by offering patients curative treatment. Screening strategies in risk populations and by means of different detection methods have been economically evaluated. However, a synthesis of screening studies to inform resource allocation towards early detection within the disease area has not been done. Therefore, studies evaluating the cost-effectiveness and costs of screening for pancreatic cancer should be systematically reviewed.
METHODS: A systematic review of economic evaluations reporting the cost-effectiveness or costs of pancreatic cancer screening will be conducted. The electronic databases Medline, Web of Science and EconLit will be searched without geographical or time restrictions. Two independent reviewers will select eligible studies based on predefined criteria. The study quality will be assessed using the Consolidated Health Economic Evaluation Reporting Standards statement and the Bias in Economic Evaluation checklist. One reviewer will extract relevant data and a second reviewer will cross-check compliance with the extraction sheet. Key items will include characteristics of screened individuals, the screening strategies used, and costs, health effects and cost-effectiveness as study outputs. Differences of opinion between the reviewers will be solved by consulting a third reviewer.
BACKGROUND: Ethics approval is not required for this study since no original data will be collected. The results will be disseminated through presentations at conferences and publication in a peer-reviewed journal. The results of the systematic review will inform future economic evaluations of pancreatic screening, which provide guidance for decision-making in healthcare resource prioritisation.
UNASSIGNED: CRD42023475348.

OBJECTIVE: This review aims to explore the influences of tinnitus retraining therapy (TRT) on patients with tinnitus.
METHODS: PubMed, MEDLINE, EMBASE, CINAHL, PEDro, SCOPUS, and Web of Science were screened for randomized controlled trials (RCTs) that explored the effects of TRT on patients with tinnitus from inception to June 30, 2024. The methodological quality of the included RCTs was evaluated using the physiotherapy evidence database (PEDro) scale.
RESULTS: Fifteen studies met our eligibility criteria. A total of 2069 patients with tinnitus (mean age 52.93 years; 66% male) were involved in the present review. The quality of the selected studies ranged from 5 to 8 on the PEDro scale, with a median score of 7. TRT did not provide superior effects in treating patients with tinnitus compared to tinnitus masking (TM), tinnitus educational counselling (TED), TRT with open ear hearing aids, Tailor-made notched music training (TMNMT), partial TRT, usual care, and smart TRT.
CONCLUSIONS: TRT intervention is considered a treatment option for patients with tinnitus. Combining TRT with other interventions, such as cognitive-behavioral therapy, pharmacotherapy, or tDS, may show even greater efficacy. Additional studies are strongly required to recognize the long-term effects of TRT on tinnitus, determine who most likely would benefit from the intervention regarding tinnitus type and severity, and identify the optimal treatment protocol.

BACKGROUND: Sacral nerve stimulation (SNS) has now been used as a treatment for fecal incontinence (FI) for >20 years. The aim of this systematic review was to determine the long-term efficacy of SNS on the treatment of FI.
METHODS: A comprehensive search of the MEDLINE, Embase, and Cochrane Central data bases was performed to find publications, excluding case reports, reporting outcomes of SNS treatment for FI in adults with ≥36 months of follow-up. Bias was assessed using the Risk of Bias in Non-randomized Studies-of Interventions tool. Data were summarized per reported FI-related outcomes for symptom severity and quality of life.
RESULTS: In total, 3326 publications were identified, and 36 studies containing 3770 subjects were included. All studies had a serious risk of bias. Success was variably defined by each publication and ranged from 59.4% to 87.5% for per-protocol analyses and 20.9% to 87.5% for intention-to-treat analyses. All studies reporting bowel diary data, St Mark\'s scores, and Cleveland Clinic Incontinence Scores indicated significant improvement with SNS treatment in the long term. Studies that evaluated quality-of-life outcomes also all showed improvements in quality of life as measured by the Fecal Incontinence Quality of Life Scale. The aggregate revision rate was 35.2%, and the explantation rate was 19.7%.
CONCLUSIONS: Improvements in objective and subjective outcomes at ≥36 months support using SNS for the long-term treatment of FI. Interpretation of these data is limited by a lack of comparative trials and heterogeneity of the included studies.

Background Rosacea is a chronic inflammatory disease of the skin characterised by facial erythema, oedema, telangiectasias, papules, pustules and nodules. There is a paucity of effective therapeutic modalities for the management of rosacea. Intense Pulsed Light (IPL), a modality in which flash lamps installed in an optical treatment device (head or tip) with mirrors to reflect light, has in recent times gained popularity in the management of this condition. Aim This systematic review aims to evaluate the efficacy, safety and adverse effects of IPL treatment for rosacea. Methods This systematic review was conducted in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analysis. The electronic databases searched were Medline, PubMed and Scopus databases. The Risk of bias in non-randomised studies of interventions (ROBINS-I) and risk-of-bias tools for randomised trials (RoB-2) was employed to assess the risk of bias. Results Of a total of 233 articles retrieved from Medline, Scopus and PubMed databases, 14 studies qualified for final analysis. The studies included patients with Fitzpatrick skin types I to IV, with ages ranging from 15 to 78 years. Although the included studies showed heterogeneity between the parameters used, most studies demonstrated positive effects of IPL treatment on telangiectasia and erythema in rosacea and that the adverse effects presented were transitory. Limitation The methodological quality of the included studies was poor. Conclusion Although most studies showed the efficacy of IPL in the treatment of rosacea, the poor quality of the studies was of concern.