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According to Global Initiative for Asthma (GINA) guidelines, long-acting muscarinic antagonists (LAMAs) should be considered as add-on therapy in patients with asthma that remains uncontrolled, despite treatment with medium-dose (MD) or high-dose (HD) inhaled corticosteroids (ICS)/long-acting β2-agonist (LABA) combinations. In patients ≥ 18 years, LAMA may be added in triple combination with an ICS and a LABA. To date, the precise efficacy of triple ICS/LABA/LAMA combination remains uncertain concerning the impact on exacerbation risk in patients with uncontrolled asthma. Therefore, an umbrella review was performed to systematically summarize available data on the effect of triple ICS/LABA/LAMA combination on the risk of asthma exacerbation. An umbrella review has been performed according to the PRIOR statement. The overall results obtained from 5 systematic reviews and meta-analyses suggest that triple ICS/LABA/LAMA combination reduces the risk of asthma exacerbation. HD-ICS showed a greater effect particularly in reducing severe asthma exacerbation, especially in patients with evidence of type 2 inflammation biomarkers. The findings of this umbrella review suggest an optimization of ICS dose in triple ICS/LABA/LAMA combination, based on the severity of exacerbation and type 2 biomarkers expression. [ABSTRACT FROM AUTHOR]

BackgroundTo clarify whether Vitamin D prevent the occurrence of type 2 diabetes mellitus (T2DM) and improve glucose control in T2DM patients, we conducted this umbrella review, taking into account the inconsistent results of existing Meta-analyses. We aim to reveal the causal relationship between Vitamin D and T2DM through summarizing Meta-analyses of observational studies, and clarify the improvement on glucose control in T2DM patients through summarizing Meta-analyses of RCT studies between Vitamin D supplementation and T2DM patients, especially in T2DM patients with Vitamin D deficiency.MethodsWe collected the Meta-analyses of observational studies and RCTs in PubMed, Scopus, Embase, Web of Science, and Cochrane.Results16 Meta-analyses (6 effect sizes for cohort studies and 10 effect sizes for RCTs) were included in the umbrella Meta-analyses. Random-effects model was carried out to calculate the pooled point estimates and their respective 95% confidence intervals (CI). The results revealed that lower 25(OH)D levels increased the risk of T2DM (Pooled ESRR = 1.34; 95%CI: 1.16, 1.53), Vitamin D supplementation ameliorated FBG (ES = −0.56; 95%CI: −1.00, −0.11), HbA1c (ES = −0.11; 95%CI: −0.20, −0.02), insulin (ES = −0.38; 95%CI: −0.59, −0.18) and HOMA-IR (ES = −0.37; 95%CI: −0.57, −0.16) in T2DM patients, especially in those with Vitamin D deficiency (FBG = −0.98; HbA1c = −0.27; HOMA-IR = −0.52).ConclusionThe present umbrella Meta-analyses demonstrates the potential benefits of higher serum Vitamin D levels and Vitamin D supplementation in reducing the development and symptoms of T2DM.

BackgroundComplications related to diabetic foot ulcers (DFU) due to diabetes are increasing. One of the factors influencing the management and treatment of complications related to DFU is the vitamin D serum levels of patients. Therefore, we sought to comprehensively review meta-analyses from randomized controlled trials and observational studies examining the link between serum vitamin D levels and DFU outcomes in diabetic patients.MethodsWe searched PubMed, Scopus, and ISI Web of Science until September 2024 and extracted the required data from related articles according to Inclusion criteria. The certainty of the evidence and the quality of conduct of the published meta-analyses were rated using the ASMTAR 2 tools, respectively.ResultA total of 8 meta-analyses studies that met inclusion criteria were included. Based on the obtained results, it has been noted that individuals with DFU exhibit serum vitamin D levels significantly lower, ranging from −7.14 (5.44, 8.83) to −0.93 (95% CI: 0.17, 1.68) ng/ml, compared to those with diabetes but without DFU. Furthermore, individuals exhibiting severe vitamin D deficiency are found to be at least 1.82 times more susceptible to developing DFU. Conversely, administering varying doses of vitamin D supplementation has been shown to positively affect the size and number of ulcers in DFU patients.ConclusionThis study suggests a potential link between lower levels of vitamin D in the blood and the risk of DFU, hinting at the benefits of vitamin D supplementation in improving outcomes associated with DFU. However, caution is warranted due to the potential bias present in the included studies.

IntroductionResilience is the dynamic adaptive process of maintaining or recovering mental health from stressors, such as trauma, challenging life circumstances, critical transitions, or physical illnesses. Resilience after adversity can be fostered through protective factors and the implementation of interventions that promote resilience. Hence, it is essential to investigate both protective and vulnerable factors to reduce the negative effects of unfavorable life events and increase resilience through positive risk-response interventions.ObjectiveTo assess the effect of previous adversity, protecting factors, and resilience-promoting interventions to possess resilience after adversity in a global context.MethodsThe study included English language articles sourced from PubMed, Embase, Scopus, Web of Sciences, the Cochrane Database of Systematic Reviews, Scopus, and Google Scholar published before 15 April 2024. These articles reported the effect of adversity, protecting factors, and/or resilience-promoting interventions to possess resilience after adversity in a global context without a population age limitation. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews. A weighted inverse-variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.ResultsA total of 44 articles (n = 556,920 participants) were included in this umbrella review. From the random-effects model analysis, the pooled effect of adversity on the development of resilience was 0.25 (p < 0.001). The pooled effects of adversity-protective factors and resilience-promoting interventions after adversity were 0.31 (p < 0.001) and 0.42 (p < 0.001), respectively. The pooled effects of specific adversity protective factors were 0.26, 0.09, 0.05, 0.34, 0.23, and 0.43 for the availability of support, cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, respectively. The pooled effects of specific resilience-promoting interventions were 0.30, 0.21, 0.51, and 0.52 for cognitive behavior therapy (CBT) interventions, mindfulness-based interventions, mixed interventions, and resilience-promoting interventions, respectively.ConclusionThe findings of this umbrella review revealed that people who experienced early adversity can develop resilience later in life. The study highlights the need to consider adversity protective factors, such as availability of support (family, friends, and school), cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, and resilience-promoting interventions, including CBT interventions, mindfulness-based interventions, and mixed interventions, to enhance resilience promotion programs.

IntroductionThe prevalence of diet-related non-communicable diseases has increased. A low-carbohydrate diet (LCDs) is one of the most popular interventions. Several systematic reviews and meta-analyses of randomised clinical trials (RCTs) and non-RCTs have linked LCDs to the management of obesity, diabetes, cardiovascular disease, epilepsy, and cancer. However, there has been limited appraisal of the strength and quality of this evidence.ObjectiveTo systematically appraise existing meta-analyses and systematic reviews of RCTs and non-RCTs on the effects of LCDs on different health conditions. To understand their potential efficacy, we summarised the studies' findings and assessed the strength of the evidence.MethodsA search was conducted using the PubMed database from inception to October 2021 for systematic reviews and meta-analyses of RCTs and non-RCTs investigating the association between LCDs and multiple health outcomes in humans. The Academy of Nutrition and Dietetics Quality Criteria was used for the quality assessment. In addition, the evolution of heterogeneity, strength of the included studies, and effect sizes were extracted from each systematic review and meta-analysis.ResultsTen systematic reviews and meta-analyses were included. Of the included reviews, 70% were of positive quality, 30% were neutral, and none were negative. The majority of the studies included strength in each systematic review, and the meta-analyses were of low to medium strength. The existing literature indicates that LCDs may help promote weight reduction in adults who are obese or overweight. This conclusion is supported by the findings of studies included in the analysis, which were of low to moderate strength. Furthermore, compelling data indicates a significant association between low-carbohydrate diets (LCDs) and a reduction in haemoglobin A1c levels among those diagnosed with type 2 diabetes mellitus. In contrast, there was a lack of evidence of this correlation in type 1 diabetes mellitus patients or those with cardiovascular diseases. Additionally, there was limited evidence regarding the effectiveness of LCDs in epilepsy and adult cancer patients.ConclusionThis review thoroughly examines the current body of information on how LCDs affect various health outcomes. Studies have presented evidence to support the idea that incorporating LCDs can positively influence weight management and HbA1c levels. However, there is a lack of information regarding the association between LCDs and individuals with Type 1 diabetes mellitus and cardiovascular diseases. Additionally, there is limited empirical evidence to substantiate the effectiveness of LCDs in the treatment of epilepsy and adult cancer patients. The long-term effects of LCDs on mortality and other chronic diseases that account for different carbohydrate subtypes is unclear. Further longitudinal cohort studies are required to reach definitive conclusions.

This study aimed to conduct an umbrella review of meta-analyses to synthesize the existing evidence regarding the relationship between vitamin D receptor (VDR) polymorphism and breast cancer (BC) risk. A comprehensive search was performed across multiple databases, including Embase, PubMed, Scopus, the Cochrane Database of Systematic Reviews, and the Web of Science. The investigation included 17 meta-analyses for the BsmI polymorphism, 6 for the Cdx2 polymorphism, and 6 for the Poly (A) polymorphism. Among the 119 datasets analyzed, only 6 (5 %) reported statistically significant outcomes (p

Introduction: A dental autotransplant is a controlled case of dental avulsion based on the transplantation of erupted teeth within the same individual, from one place to another, in sites where an extraction was performed or that were surgically prepared. Autotransplantation has become a viable method to replace lost teeth since transplanted teeth may operate as fully normal teeth. Objective: The objective of this study was to summarize the available scientific evidence regarding predictors of success in autotransplanted teeth. Materials and Methods: A systematic review of systematic reviews, known as an umbrella review, was performed. Two calibrated and standardized investigators independently analyzed the quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and evaluated the confidence level and bias review with the Amstar-2 guideline. The PubMed, Embase, and Scopus databases were used. The search was conducted in August 2022 and updated on March 22, 2023. Systematic reviews or meta-analyses carried out from publications on human beings, between 2017 and 2022, were included. Results: From 104 achieved, 4 systematic reviews and meta-analyses were assessed. The overall survival of autotransplanted teeth ranged from 81% to 98%, the prevalence of overall inflammatory root resorption ranged from 2.1% to 43%, and the prevalence of ankylosis ranged from 1.2% to 43%. Predictive factors for success identified in the literature included tooth type or root development and clinical intervention factors, including socket preparation, splinting, occlusion control, antibiotic regimen, treatment time of endodontics, and orthodontic treatment. Conclusions: The existing evidence on autotransplanted teeth in humans indicates that the survival rate of such teeth involves a series of presurgical and surgical variables. Analyses of factors associated with complications or failures still require primary studies where associations may be made to draw more solid conclusions.

Abstract Background Numerous meta-analyses have explored the association between the triglyceride-glucose (TyG) index and diverse health outcomes, yet the comprehensive assessment of the scope, validity, and quality of this evidence remains incomplete. Our aim was to systematically review and synthesise existing meta-analyses of TyG index and health outcomes and to assess the quality of the evidence. Methods A thorough search of PubMed, EMBASE, and Web of Science databases was conducted from their inception through to 8 April 2024. We assessed the quality of reviews using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. This study was registered with PROSPERO (CRD: 42024518587). Results Overall, a total of 95 associations from 29 meta-analyses were included, investigating associations between TyG index and 30 health outcomes. Of these, 83 (87.4%) associations were statistically significant (P

Abstract Background Adherence to physiotherapeutic treatment and recommendations is crucial to achieving planned goals and desired health outcomes. This overview of systematic reviews synthesises the wide range of additional interventions and behaviour change techniques used in physiotherapy, exercise therapy and physical therapy to promote adherence and summarises the evidence of their efficacy. Methods Seven databases (PEDro, PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO and CINAHL) were systematically searched with terms related to physiotherapy, motivation, behaviour change, adherence and efficacy (last searched on January 31, 2023). Only systematic reviews of randomised control trials with adults were included. The screening process and quality assessment with AMSTAR-2 were conducted independently by the two authors. The extracted data was synthesised narratively. In addition, four meta-analyses were pooled in a panoramic meta-analysis. Results Of 187 reviews identified in the search, 19 were included, comprising 205 unique trials. Four meta-analyses on the effects of booster sessions, behaviour change techniques, goal setting and motivational interventions showed a significantly small overall effect (SMD 0.24, 95% CI 0.13, 0.34) and no statistical heterogeneity (I 2 = 0%) in the panoramic meta-analysis. Narrative synthesis revealed substantial clinical and methodological diversity. In total, the certainty of evidence is low regarding the efficacy of the investigated interventions and techniques on adherence, due to various methodological flaws. Most of the RCTs that were included in the reviews analysed cognitive and behavioural interventions in patients with musculoskeletal diseases, indicating moderate evidence for the efficacy of some techniques, particularly, booster sessions, supervision and graded exercise. The reviews provided less evidence for the efficacy of educational and psychosocial interventions and partly inconsistent findings. Most of the available evidence refers to short to medium-term efficacy. The combination of a higher number of behaviour change techniques was more efficacious. Conclusions The overview of reviews synthesised various potentially efficacious techniques that may be combined for a holistic and patient-centred approach and may support tailoring complex interventions to the patient’s needs and dispositions. It also identifies various research gaps and calls for a more holistic approach to define and measure adherence in physiotherapy. Systematic review registration PROSPERO CRD42021267355.

Abstract Background Women who live with disadvantages such as socioeconomic deprivation, substance misuse, poor mental health, or domestic abuse face inequalities in health before, during, and after pregnancy and for their infants through to childhood. Women do not experience these factors alone; they accumulate and interact. Therefore, there is a need for an overview of interventions that work across health and social care and target women at risk of inequalities in maternal or child health. Methods Systematic review methodology will be used to identify systematic reviews from high-income countries that describe interventions aiming to reduce inequalities for women who experience social disadvantage during pregnancy. We will describe the range of interventions and their effectiveness in reducing inequalities in maternal or child health. Any individual, hospital, or community-level activity specific to women during the pre-conception, antenatal, or postpartum period up to 1 year after birth will be included, regardless of the setting in which they are delivered. We will search eight electronic databases with the pre-determined search strategy and supplement them with extensive grey literature searches. We will present a narrative synthesis, taking into account the quality assessment and coverage of included studies. Discussion Inequalities in maternal and child health are a key priority area for national policymakers. Understanding the range and effectiveness of interventions across the perinatal period will inform policy and practice. Identifying gaps in the evidence will inform future research. Systematic review registration PROSPERO CRD42023455502.

Abstract Background Numerous studies have been conducted to investigate the relationship between ABO and Rhesus (Rh) blood groups and various health outcomes. However, a comprehensive evaluation of the robustness of these associations is still lacking. Methods We searched PubMed, Web of Science, Embase, Scopus, Cochrane, and several regional databases from their inception until Feb 16, 2024, with the aim of identifying systematic reviews with meta-analyses of observational studies exploring associations between ABO and Rh blood groups and diverse health outcomes. For each association, we calculated the summary effect sizes, corresponding 95% confidence intervals, 95% prediction interval, heterogeneity, small-study effect, and evaluation of excess significance bias. The evidence was evaluated on a grading scale that ranged from convincing (Class I) to weak (Class IV). We assessed the certainty of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation criteria (GRADE). We also evaluated the methodological quality of included studies using the A Measurement Tool to Assess Systematic Reviews (AMSTAR). AMSTAR contains 11 items, which were scored as high (8–11), moderate (4–7), and low (0–3) quality. We have gotten the registration for protocol on the PROSPERO database (CRD42023409547). Results The current umbrella review included 51 systematic reviews with meta-analysis articles with 270 associations. We re-calculated each association and found only one convincing evidence (Class I) for an association between blood group B and type 2 diabetes mellitus risk compared with the non-B blood group. It had a summary odds ratio of 1.28 (95% confidence interval: 1.17, 1.40), was supported by 6870 cases with small heterogeneity (I 2 = 13%) and 95% prediction intervals excluding the null value, and without hints of small-study effects (P for Egger’s test > 0.10, but the largest study effect was not more conservative than the summary effect size) or excess of significance (P

Introduction Acupuncture and related acupoint therapies have been widely used for smoking cessation. Some relevant systematic reviews (SRs) have been published. There is a need to summarize and update the evidence to inform practice and decision-making. Methods Eight databases were searched from their inception to December 2023. SRs, any randomized controlled trials (RCTs) comparing acupuncture therapies with sham acupuncture, pharmacotherapy, behavioral therapy, or no treatment, were included. The primary outcome was the abstinence rate. AMSTAR-2 was employed to assess the quality of SRs. An updated meta-analysis was conducted based on SRs and RCTs. Data were synthesized using risk ratios (RR) with 95% confidence intervals (CIs). The GRADE approach was employed to assess the certainty of the updated evidence. Results Thirteen SRs and 20 RCTs outside of the SRs were identified. The SRs were of low or very low quality by AMSTAR-2. Sixteen (80%) RCTs were at high risk of performance bias. Eight acupuncture and related acupoint therapies were involved. The short-term (≤6 months) abstinence rate outcome was summarized as follows. Most SRs suggested that filiform needle acupuncture or acupressure had a better effect than sham acupuncture, but the findings were inconsistent. The updated meta-analysis also suggested that filiform needle acupuncture was more effective than sham acupuncture (RR=1.44; 95% CI: 1.02–2.02; I 2 = 66%; low certainty; 9 RCTs, n=1358). Filiform needle acupuncture combined with acupressure was comparable to nicotine patches (RR=0.99; 95% CI: 0.74–1.32; low certainty; 6 RCTs, n= 524). Acupressure was superior to counseling (RR=1.46; 95% CI: 1.14–1.87; I 2 =5%; low certainty; 8 RCTs, n=595). No serious adverse events were reported in these SRs or RCTs. Conclusions Low certainty evidence suggests that filiform needle acupuncture and auricular acupressure appear to be safe and effective in achieving short-term smoking cessation. However, long-term follow-up data are needed.

Abstract Background In this umbrella review, we systematically evaluated the evidence from meta-analyses and systematic reviews of maternal factors associated with low birth weight. Methods PubMed, Scopus, and Web of Science were searched to identify all relevant published studies up to August 2023. We included all meta-analysis studies (based on cohort, case-control, cross-sectional studies) that examined the association between maternal factors (15 risk factors) and risk of LBW, regardless of publication date. A random-effects meta-analysis was conducted to estimate the summary effect size along with the 95% confidence interval (CI), 95% prediction interval, and heterogeneity (I2) in all meta-analyses. Hedges’ g was used as the effect size metric. The effects of small studies and excess significance biases were assessed using funnel plots and the Egger’s test, respectively. The methodological quality of the included studies was assessed using the AMSTAR 2 tool. Results We included 13 systematic Review with 15 meta-analysis studies in our study based on the inclusion criteria. The following 13 maternal factors were identified as risk factors for low birth weight: crack/cocaine (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.26–3.52), infertility (OR 1.34, 95% CI 1.2–1.48), smoking (OR 2.00, 95% CI 1.76–2.28), periodontal disease (OR 2.41, 95% CI 1.67–3.47), depression (OR 1.84, 95% CI 1.34–2.53), anemia (OR 1.32, 95% CI 1.13–1.55), caffeine/coffee (OR 1.34, 95% CI 1.14–1.57), heavy physical workload (OR 1.87, 95% CI 1.00-3.47), lifting ≥ 11 kg (OR 1.59, 95% CI 1.02–2.48), underweight (OR 1.79, 95% CI 1.20–2.67), alcohol (OR 1.23, 95% CI 1.04–1.46), hypertension (OR 3.90, 95% CI 2.73–5.58), and hypothyroidism (OR 1.40, 95% CI 1.01–1.94). A significant negative association was also reported between antenatal care and low birth weight. Conclusions This umbrella review identified drug use (such as crack/cocaine), infertility, smoking, periodontal disease, depression, caffeine and anemia as risk factors for low birth weight in pregnant women. These findings suggest that pregnant women can reduce the risk of low birth weight by maintaining good oral health, eating a healthy diet, managing stress and mental health, and avoiding smoking and drug use.

Abstract Background Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN. Methods A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares. Results Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86–9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85–6.65), 3.58 (95% CI 2.75–4.66), and 2.85 (95% CI 2.13–3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17–0.37), ES: 0.25 (95% CI 0.13–0.50), ES: 0.26 (95% CI 0.17–0.41), and ES: 0.39 (0.28–0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P

Abstract Background Patient-reported outcome and experience measures (PROMs and PREMs, respectively) are evidence-based, standardized questionnaires that can be used to capture patients’ perspectives of their health and health care. While substantial investments have been made in the implementation of PROMs and PREMs, their use remains fragmented and limited in many settings. Analysis of multi-level barriers and enablers to the implementation of PROMs and PREMs has been hampered by the lack of use of state-of-the-art implementation science frameworks. This umbrella review aims to consolidate available evidence from existing quantitative, qualitative, and mixed-methods systematic and scoping reviews covering factors that influence the implementation of PROMs and PREMs in healthcare settings. Methods An umbrella review of systematic and scoping reviews will be conducted following the guidelines of the Joanna Briggs Institute (JBI). Qualitative, quantitative, and mixed methods reviews of studies focusing on the implementation of PROMs and/or PREMs in all healthcare settings will be considered for inclusion. Eight bibliographical databases will be searched. All review steps will be conducted by two reviewers independently. Included reviews will be appraised and data will be extracted in four steps: (1) assessing the methodological quality of reviews using the JBI Critical Appraisal Checklist; (2) extracting data from included reviews; (3) theory-based coding of barriers and enablers using the Consolidated Framework for Implementation Research (CFIR) 2.0; and (4) identifying the barriers and enablers best supported by reviews using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. Findings will be presented in diagrammatic and tabular forms in a manner that aligns with the objective and scope of this umbrella review, along with a narrative summary. Discussion This umbrella review of quantitative, qualitative, and mixed-methods systematic and scoping reviews will inform policymakers, researchers, managers, and clinicians regarding which factors hamper or enable the adoption and sustained use of PROMs and PREMs in healthcare settings, and the level of confidence in the evidence supporting these factors. Findings will orient the selection and adaptation of implementation strategies tailored to the factors identified. Systematic review registration PROSPERO CRD42023421845.

Abstract Background Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one’s lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus. Methods In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg’s FSN was calculated for both binary and continuous measures. Results We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression. Conclusions The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.

Various dietary patterns (DPs) may benefit or harm cognitive status through their components. Publications assessing the impact of DPs on cognitive scores using neuropsychological tests have often led to less promising results. Recently, numerous meta-analyses and systematic reviews have utilized neuroimaging to identify more subtle brain-associated alterations related to cognition. Combining neuroimaging methods with neuropsychological assessments could clarify these findings. This umbrella review was conducted to systematically explore evidence on the impact of DPs on neuroimaging biomarkers in older adults with cognitive disorders. Scientific databases, including Scopus, PubMed, and Web of Science, were comprehensively searched from the earliest available data until May 11, 2024. Out of 89 papers, 15 meta-analyses and systematic reviews were included in our umbrella review. These selected papers addressed 27 DPs and their impact on neuroimaging biomarkers. Most selected papers were of moderate quality. Studies revealed that greater adherence to the Mediterranean diet (MedDiet) correlated with increased cortical thickness, improved glucose metabolism in the brain, and reduced amyloid-beta and tau deposition, as evidenced by magnetic resonance imaging and other neuroimaging techniques. Higher adherence to healthy DPs, such as the MedDiet, reduced the risk of Alzheimer's disease and mild cognitive impairment. In contrast, Western and high glycemic diets were associated with increased cognitive decline.

Background: Diet significantly influences the risk of developing cardiovascular disease (CVD), the leading cause of death in the United States. As vegetarian dietary patterns are increasingly being included within clinical practice guidelines, there is a need to review the most recent evidence regarding if and how these dietary patterns mitigate CVD risk. Objective: This umbrella review of systematic reviews compared the relationships between vegetarian, vegan and non-vegetarian dietary patterns and CVD health outcomes and risk factors among presumably healthy adults (≥18 years) in the general population. Methods: MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, Food Science Source and SportsDiscus databases were searched for systematic reviews (SRs) published from 2018 until March 2024. Eligible SRs and meta-analyses examined relationships between vegetarian or vegan diets and CVD risk factors and disease outcomes compared to non-vegetarian diets. SRs were screened in duplicate, and SR quality was assessed with AMSTAR2. The overall certainty of evidence (COE) was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) method. Results: There were 758 articles identified in the databases’ search and 21 SRs met inclusion criteria. SRs targeting the general population had primarily observational evidence. Vegetarian, including vegan, dietary patterns were associated with reduced risk for CVD incidence [Relative Risk: 0.85 (0.79, 0.92)] and CVD mortality [Hazard Ratio: 0.92 (0.85, 0.99)] compared to non-vegetarian diets. Vegan dietary patterns were associated with reductions in CVD risk factors including blood pressure [systolic mean difference (95 % CI): -2.56 mmHg (-4.66, -0.445)], low-density lipoprotein cholesterol [-0.49 mmol/l (-0.62, -0.36)], and body mass index [-1.72 kg/m2 (-2.30, -1.16)] compared to non-vegetarian dietary patterns, as well as c-reactive protein concentrations in a novel meta-analysis [-0.55 mg/l (-1.07, -0.03)]. Conclusion: Practitioners can consider recommending vegetarian dietary patterns to reduce cardiometabolic risk factors and risk of CVD incidence and mortality.

AbstractDespite the wealth of literature on factors influencing student entrepreneurial intentions (SEIs), as well as several review articles having provided an overview, the complexity of their interrelationships remains inadequately understood. Furthermore, the scattered use and adoption of theories by review articles to present their findings makes it even more difficult to create a comparative overview and could prevent integration. In this article, we address this and conduct a systematic literature review (SLR) of 23 review articles. As such, we provide an overview of the factors influencing SEI and outline how they are interrelated, unravelling much-needed research avenues in this study domain. The study reveals that the theory of planned behaviour (TPB) and entrepreneurial event theory (EET) is predominant in SEI research. It identifies 63 factors affecting SEI, categorised into seven groups, with notable interrelations within and across them. Based on the gaps and trends identified in this review of reviews, future recommendations are put forward for researchers and entrepreneurship policymakers to ensure the effective development of an entrepreneurial environment to cultivate SEI.

Background: Women who live with disadvantages such as socioeconomic deprivation, substance misuse, poor mental health, or domestic abuse face inequalities in health before, during, and after pregnancy and for their infants through to childhood. Women do not experience these factors alone; they accumulate and interact. Therefore, there is a need for an overview of interventions that work across health and social care and target women at risk of inequalities in maternal or child health. Methods: Systematic review methodology will be used to identify systematic reviews from high-income countries that describe interventions aiming to reduce inequalities for women who experience social disadvantage during pregnancy. We will describe the range of interventions and their effectiveness in reducing inequalities in maternal or child health. Any individual, hospital, or community-level activity specific to women during the pre-conception, antenatal, or postpartum period up to 1 year after birth will be included, regardless of the setting in which they are delivered. We will search eight electronic databases with the pre-determined search strategy and supplement them with extensive grey literature searches. We will present a narrative synthesis, taking into account the quality assessment and coverage of included studies. Discussion: Inequalities in maternal and child health are a key priority area for national policymakers. Understanding the range and effectiveness of interventions across the perinatal period will inform policy and practice. Identifying gaps in the evidence will inform future research. Systematic review registration: PROSPERO CRD42023455502. [ABSTRACT FROM AUTHOR]

Background: Numerous meta-analyses have explored the association between the triglyceride-glucose (TyG) index and diverse health outcomes, yet the comprehensive assessment of the scope, validity, and quality of this evidence remains incomplete. Our aim was to systematically review and synthesise existing meta-analyses of TyG index and health outcomes and to assess the quality of the evidence. Methods: A thorough search of PubMed, EMBASE, and Web of Science databases was conducted from their inception through to 8 April 2024. We assessed the quality of reviews using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. This study was registered with PROSPERO (CRD: 42024518587). Results: Overall, a total of 95 associations from 29 meta-analyses were included, investigating associations between TyG index and 30 health outcomes. Of these, 83 (87.4%) associations were statistically significant (P < 0.05) according to the random effects model. Based on the AMSTAR tool, 16 (55.2%) meta-analyses were high quality and none was low quality. The certainty of the evidence, assessed by the GRADE framework, showed that 6 (6.3%) associations were supported by moderate-quality evidence. When compared with the lowest category of the TyG index, the risk of contrast-induced nephropathy (CIN) [relative risk (RR) = 2.25, 95%CI 1.82, 2.77], the risk of stroke in patients with diabetes mellitus (RR = 1.26, 95%CI 1.18, 1.33) or with acute coronary syndrome disease (RR = 1.56, 95%CI 1.06, 2.28), the prognosis of coronary artery disease (CAD)-non-fatal MI (RR = 2.02, 95%CI 1.32, 3.10), and the severity of CAD including coronary artery stenosis (RR = 3.49, 95%CI 1.71, 7.12) and multi-vessel CAD (RR = 2.33, 95%CI 1.59, 3.42) increased with high TyG index. Conclusion: We found that the TyG index was positively associated with many diseases including the risk of CIN and stroke, the prognosis of CAD, and the severity of CAD which were supported by moderate-quality evidence. TyG index might be useful to identify people at high-risk for developing these diseases. [ABSTRACT FROM AUTHOR]

Background: Adherence to physiotherapeutic treatment and recommendations is crucial to achieving planned goals and desired health outcomes. This overview of systematic reviews synthesises the wide range of additional interventions and behaviour change techniques used in physiotherapy, exercise therapy and physical therapy to promote adherence and summarises the evidence of their efficacy. Methods: Seven databases (PEDro, PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO and CINAHL) were systematically searched with terms related to physiotherapy, motivation, behaviour change, adherence and efficacy (last searched on January 31, 2023). Only systematic reviews of randomised control trials with adults were included. The screening process and quality assessment with AMSTAR-2 were conducted independently by the two authors. The extracted data was synthesised narratively. In addition, four meta-analyses were pooled in a panoramic meta-analysis. Results: Of 187 reviews identified in the search, 19 were included, comprising 205 unique trials. Four meta-analyses on the effects of booster sessions, behaviour change techniques, goal setting and motivational interventions showed a significantly small overall effect (SMD 0.24, 95% CI 0.13, 0.34) and no statistical heterogeneity (I2 = 0%) in the panoramic meta-analysis. Narrative synthesis revealed substantial clinical and methodological diversity. In total, the certainty of evidence is low regarding the efficacy of the investigated interventions and techniques on adherence, due to various methodological flaws. Most of the RCTs that were included in the reviews analysed cognitive and behavioural interventions in patients with musculoskeletal diseases, indicating moderate evidence for the efficacy of some techniques, particularly, booster sessions, supervision and graded exercise. The reviews provided less evidence for the efficacy of educational and psychosocial interventions and partly inconsistent findings. Most of the available evidence refers to short to medium-term efficacy. The combination of a higher number of behaviour change techniques was more efficacious. Conclusions: The overview of reviews synthesised various potentially efficacious techniques that may be combined for a holistic and patient-centred approach and may support tailoring complex interventions to the patient's needs and dispositions. It also identifies various research gaps and calls for a more holistic approach to define and measure adherence in physiotherapy. Systematic review registration: PROSPERO CRD42021267355. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) significantly impact lifelong health and well‐being. Despite extensive research, a comprehensive understanding of ACEs' multifaceted impacts continues to be challenging to achieve. This study synthesizes meta‐analytic evidence to provide a comprehensive view of ACEs' effects, addressing various approaches to conceptualizing ACEs and their diverse outcomes. Employing an umbrella synthesis methodology, this review integrated findings from 99 meta‐analyses involving 592 effect sizes. We examined ACEs through specificity, lumping, dimensional, and child maltreatment‐centric approaches, assessing their impact across six domains: biological system dysregulation, neuropsychological impairments, physical health complications, mental health conditions, social and behavioral challenges, and criminal justice involvement. The findings reveal a small to moderate overall effect size of ACEs across outcome domains. Specific ACE approaches exhibited varying impact levels, with notable differences in effects on mental health, social/behavioral issues, and criminal justice involvement. When ACEs were aggregated without distinguishing between different types, but with consideration of their cumulative effects, adverse outcomes were significantly exacerbated. The child maltreatment‐centric approach consistently demonstrated substantial effects across all evaluated domains. This review underscores the heterogeneity in ACEs' impacts, influenced by the type of ACE and specific outcomes considered. It highlights the necessity for comprehensive approaches to understanding, preventing, and mitigating the effects of ACEs. These insights are vital for developing targeted interventions and informing policy‐making, emphasizing the complexity and varied nature of ACEs' influence on individual development and societal well‐being. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have been conducted to investigate the relationship between ABO and Rhesus (Rh) blood groups and various health outcomes. However, a comprehensive evaluation of the robustness of these associations is still lacking. Methods: We searched PubMed, Web of Science, Embase, Scopus, Cochrane, and several regional databases from their inception until Feb 16, 2024, with the aim of identifying systematic reviews with meta-analyses of observational studies exploring associations between ABO and Rh blood groups and diverse health outcomes. For each association, we calculated the summary effect sizes, corresponding 95% confidence intervals, 95% prediction interval, heterogeneity, small-study effect, and evaluation of excess significance bias. The evidence was evaluated on a grading scale that ranged from convincing (Class I) to weak (Class IV). We assessed the certainty of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation criteria (GRADE). We also evaluated the methodological quality of included studies using the A Measurement Tool to Assess Systematic Reviews (AMSTAR). AMSTAR contains 11 items, which were scored as high (8–11), moderate (4–7), and low (0–3) quality. We have gotten the registration for protocol on the PROSPERO database (CRD42023409547). Results: The current umbrella review included 51 systematic reviews with meta-analysis articles with 270 associations. We re-calculated each association and found only one convincing evidence (Class I) for an association between blood group B and type 2 diabetes mellitus risk compared with the non-B blood group. It had a summary odds ratio of 1.28 (95% confidence interval: 1.17, 1.40), was supported by 6870 cases with small heterogeneity (I2 = 13%) and 95% prediction intervals excluding the null value, and without hints of small-study effects (P for Egger's test > 0.10, but the largest study effect was not more conservative than the summary effect size) or excess of significance (P < 0.10, but the value of observed less than expected). And the article was demonstrated with high methodological quality using AMSTAR (score = 9). According to AMSTAR, 18, 32, and 11 studies were categorized as high, moderate, and low quality, respectively. Nine statistically significant associations reached moderate quality based on GRADE. Conclusions: Our findings suggest a potential relationship between ABO and Rh blood groups and adverse health outcomes. Particularly the association between blood group B and type 2 diabetes mellitus risk. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is a leading cause of death worldwide, with a significant number of patients presenting with liver metastases at diagnosis. The best treatment currently involves the surgical removal of these metastases, yet the optimal timing and method for this surgery are still debated among experts. Our analysis revealed no significant difference in overall survival and disease-free survival between a simultaneous surgery approach and a "bowel-first" approach, while a better 5-year overall survival (5-OS) was found when comparing the former to a "liver-first" approach. However, simultaneous surgeries are associated with a higher risk of perioperative mortality, suggesting that staged surgery might be more beneficial for high-risk patients. This emphasizes the need for personalized treatment plans. Our findings also suggest that anatomic and non-anatomic resections offer similar long-term survival benefits, highlighting the potential for more conservative surgeries to preserve liver function without compromising the effectiveness of cancer treatment. Surgical resection is the gold standard for treating synchronous colorectal liver metastases (CRLM). The resection of the primary tumor and metastatic lesions can follow different sequences: "simultaneous", "bowel-first", and "liver-first". Conservative approaches, such as parenchymal-sparing surgery and segmentectomy, may serve as alternatives to major hepatectomy. A comprehensive search of Medline, Epistemonikos, Scopus, and the Cochrane Library was conducted. Studies evaluating patients who underwent surgery for CRLM and reported survival results were included. Other secondary outcomes were analyzed, including disease-free survival, perioperative complications and mortality, and recurrence rates. Quality assessment was performed using the AMSTAR-2 method. No significant differences in overall survival, disease-free survival, and secondary outcomes were observed when comparing simultaneous to "bowel-first" resections, despite a higher rate of perioperative mortality in the former group. The 5-year OS was significantly higher for simultaneous resection compared to "liver-first" resection. No significant differences in OS and DFS were noted when comparing "liver-first" to "bowel-first" resection, or anatomic to non-anatomic resection. Our umbrella review validates simultaneous surgery as an effective oncological approach for treating SCRLM, though the increased risk of perioperative morbidity highlights the importance of selecting suitable patients. Non-anatomic resections might be favored to preserve liver function and enable future surgical interventions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary intervention and diabetic nephropathy (DN). Methods: We conducted an umbrella review of existing meta-analyses of randomized controlled trials (RCTs) that focused on the effects of dietary intervention on DN incidence. The literature was searched via PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. According to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), evidence of each outcome was evaluated and graded as "high", "moderate", "low" or "very low" quality to draw conclusions. Additionally, we classified evidence of outcomes into 4 categories. Results: We identified 36 meta-analyses of RCTs and 55 clinical outcomes of DN from 395 unique articles. Moderate-quality evidence suggested that probiotic supplementation could significantly improve blood urea nitrogen (BUN), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in DN patients. Low-quality evidence indicated that probiotic supplementation significantly improved the serum creatinine concentration, urinary albumin-creatinine ratio (UACR), fasting blood glucose (FBG), HbA1c and high-density lipoprotein cholesterol (HDL-C) in DN patients. In addition, low-quality evidence suggested that a salt restriction diet could significantly improve the creatinine clearance rate (CrCl) in patients with DN. Low-quality evidence suggested that vitamin D supplementation could significantly improve the UACR in patients with DN. In addition, low-quality evidence has indicated that soy isoflavone supplementation could significantly improve BUN, FBG, total cholesterol (TC), triglyceride (TG) and LDL-C levels in patients with DN. Furthermore, low-quality evidence suggested that coenzyme Q10 supplementation could significantly improve HbA1c, TC and HDL-C in patients with DN, and dietary polyphenols also significantly improved HbA1c in patients with DN. Finally, low-quality evidence suggested that supplementation with antioxidant vitamins could significantly improve the serum creatinine concentration, systolic blood pressure, and HbA1c level in patients with DN. Given the small sample size, all significantly associated outcomes were evaluated as class IV evidence. Conclusion: Moderate to low amounts of evidence suggest that supplementation with probiotics, vitamin D, soy isoflavones, coenzyme Q10, dietary polyphenols, antioxidant vitamins, or salt-restricted diets may significantly improve clinical outcomes in patients with DN. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to synthesize the evidence of the comparative effectiveness and safety of Ophiocordyceps sinensis (OS) preparations combined with renin-angiotensin system inhibitors (RASi) for diabetic kidney disease (DKD). Methods: Eight databases were searched from their inception to May 2023. Systematic reviews (SRs) of OS preparations combined with RASi for DKD were identified. Randomized controlled trials (RCTs) from the included SRs and additional searching were performed for data pooling. Cochrane risk-of-bias 2 (RoB 2) tool and AMSTAR 2 were used to evaluate the methodological quality of RCTs and SRs, respectively. A Bayesian network meta-analysis was performed to compare the add-on effect and safety of OS preparations for DKD. The certainty of evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: Fourteen SRs were included, whose methodological quality was assessed as high (1/14) or critically low (13/14). After combining additional searching, 157 RCTs were included, involving 13,143 participants. The quality of the RCTs showed some concerns (155/157) or high risk (2/157). Jinshuibao capsules and tablets, Bailing capsules and tablets, and Zhiling capsules were evaluated. Compared to RASi, adding either of the OS capsular preparations resulted in a decreased 24-h urinary total protein levels. OS preparations ranked differently in each outcome. Jinshuibao capsules plus RASi were beneficial in reducing urinary protein, serum creatinine, serum urea nitrogen, and blood glucose levels, with moderate-certainty evidence. No serious adverse events were observed after adding OS to RASi. Conclusion: Combining OS capsular preparations with RASi appeared to be associated with decreased urinary total protein levels in DKD patients. Further high-quality studies are needed to confirm. [ABSTRACT FROM AUTHOR]

This umbrella review aimed to examine and synthesize qualitative studies that explored the barriers and facilitators of advance care planning for persons with dementia, their families, and their healthcare professionals and caregivers. The modified umbrella review approach developed by the Joanna Briggs Institute was followed. Five major English databases were searched. Four reviews based on 38 primary qualitative studies were included. The methodological quality of the included reviews was moderate to high. The synthesis yielded 16 descriptive themes and five analytical themes: making the wishes/preferences of persons with dementia visible; constructive collaboration based on stakeholders having positive relationships; emotional chaos in facing end-of-life substitute decision-making; initiating the advance care planning process; and preparedness and commitment of healthcare providers to advance care planning. Comprehensive and workable strategies are required to overcome complex and interrelated barriers involving not only healthcare professionals but also organizational and systemic challenges. [ABSTRACT FROM AUTHOR]

• Valerian is one of the most commonly used herbal sleep aids. • The evidence on clinical effectiveness in sleep is very weak. • The systematic reviews and meta-analyses are scarce and heterogeneous. Valerian is one of the most used herbal agents (phytotherapeutics) to manage sleep disturbances, in particular, sleep-onset difficulties in young adults. However, the evidence based on primary studies and systematic reviews that supports its use in this domain is weak or inconclusive. In the current study, an umbrella review was performed on the efficacy of valerian for sleep disturbances with a focus on insomnia. As such, only systematic reviews (with or without meta-analysis) were considered for this study. Systematic searches in PubMed, Web of Science, Scopus, Cochrane Database of Systematic Reviews, PROSPERO and CNKI databases retrieved 70 records. Only 8 articles were considered eligible for qualitative analysis. Overall, data suggested that valerian has a good safety profile, however, the results showed no evidence of efficacy for the treatment of insomnia. Moreover, valerian appears to be effective concerning subjective improvement of sleep quality, although its effectiveness has not been demonstrated with quantitative or objective measurements. Despite its widespread use and prescription by general practitioners, psychiatrists and other professionals, valerian does not have empirical support for insomnia. Further studies, in particular high quality randomized controlled trials, are highly recommended since there are scarce studies and the existing ones are quite heterogeneous and with low methodological quality. The implications of our findings for clinical practice are critically discussed. [ABSTRACT FROM AUTHOR]

Background: High‐intensity interval training (HIIT) is characterized by repeated bouts of relatively intense exercise interspersed with recovery periods. Previous studies have evaluated this exercise strategy with various population subgroups, regimens, and comparator groups, limiting the generalizability of findings. We performed a novel umbrella review to generate an up‐to‐date synthesis of the available evidence regarding the effect of HIIT on cardiorespiratory fitness (CRF) in adults as compared to non‐exercise control and traditional continuous forms of exercise such as moderate‐intensity continuous training (MICT). Methods: An umbrella review was conducted in accordance with the Preferred Reporting Items for Overviews of Reviews guideline. Seven databases (MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science) were searched until February 2024. Systematic reviews with meta‐analyses comparing HIIT and active/non‐active control conditions were included. Literature search, data extraction, and methodological quality assessment (AMSTAR‐2) were conducted independently by two reviewers. Results: Twenty‐four systematic reviews with meta‐analyses, representing 429 primary studies and 12 967 unique participants, met the inclusion criteria. Most of the systematic reviews received moderate‐to‐critically low AMSTAR‐2 scores. The data showed that HIIT, including the particularly intense variant "sprint interval training" (SIT), significantly increases CRF in adults compared to non‐exercise control (standardized mean difference [SMD]: 0.28 to 4.31; weighted mean difference [WMD]: 3.25 to 5.5 mL/kg/min) and MICT (SMD: 0.18 to 0.99; WMD: 0.52 to 3.76 mL/kg/min). This effect was consistently observed across specific groups of individuals (e.g., apparently healthy adults, individuals with overweight/obesity, older adults, and high‐level athletes) and HIIT modalities (e.g., low‐volume HIIT, whole‐body HIIT, home‐based HIIT, aquatic HIIT, and short SIT). Conclusion: Existing evidence from systematic reviews consistently supports the effect of HIIT on enhancing CRF in adults when compared to non‐exercise control and MICT. Our findings offer a comprehensive basis that may potentially contribute to informing physical activity guidelines aimed at improving CRF in the general population. [ABSTRACT FROM AUTHOR]

Objectives: An umbrella review is a systematic review of systematic reviews, which provides a tertiary level of evidence. This umbrella review of systematic reviews and meta‐analysis (SR‐MA) aimed to determine the proportion of oral cancer (OC) development in oral submucous fibrosis (OSF) patients. Materials and Methods: We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane and grey literature. Two reviewers independently screened abstracts and assessed for eligible papers. The methodological quality of SR‐MA was evaluated using AMSTAR2, and we also checked the quality of evidence of the included papers. Results: Out of 454 papers identified in the primary search, 105 underwent eligibility screening. Inclusion criteria were met by four SR‐MA. OC ratios ranged between 4.2% and 6% for OSF. Substantial heterogeneity was observed for this outcome in all four MA (I2 = 71.31% to 86.37%). None of the SRs assessed the quality of evidence, and half of them were judged to be of critically low methodological quality. Conclusion: There is lack of quality of evidences and critically low methodological quality among SRs and MA leading to substantial heterogeneity. However, due to potentially malignant nature, OSF patients should be monitored carefully for early detection of OC. [ABSTRACT FROM AUTHOR]

Background: Caregivers of children with chronic diseases suffer from great parenting pressure, which directly affects the treatment and rehabilitation of children, reduces the quality of life of caregivers and damages family functioning. Existing reviews have not systematically summarized and evaluated interventions for parenting stress in caregivers of children with chronic diseases. Data Sources: Embase, PubMed, Web of Science, OVID, CNKI, CBM, Wan Fang and Cochrane Library were searched for eligible reviews in November 2021 and October 2022. Methods: Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using JBI. The quality of the evidence was assessed using GRADE. Findings are reported in accordance with PRISMA checklist. Narrative summaries grouped findings by intervention types. Results: Out of 2632 records, we included 21 systematic reviews for a synthesis. Interventions for parenting stress in children with chronic diseases were divided into seven categories. Cognitive behavioural interventions, psychosocial interventions, child behavioural and/or developmental parent interventions and synthesized interventions have shown high‐level evidence in reducing parenting stress for caregivers of children with chronic diseases. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions. Conclusions: This umbrella review suggest that reducing the parenting stress of caregivers of children with chronic diseases can directly target caregivers' parenting stress through cognitive behavioural interventions/psychosocial interventions and/or provide guidance to parents on the behavioural and developmental problems of children with chronic diseases. A more standardized approach to outcome measures is essential to assess efficacy and compare interventions across studies. Relevance to Clinical Practice: The findings provide information and evidence for reducing parenting stress among caregivers of children with chronic diseases to guide the development of comprehensive intervention strategies. Patient or Public Contribution: Patient or public contribution does not apply to this study. [ABSTRACT FROM AUTHOR]

Review studies are vital for advancing knowledge in many scientific fields, including mathematics education, amid burgeoning publications. Based on an extensive consideration of existing review typologies, we conducted a meta-review and bibliometric analysis to provide a comprehensive overview of and deeper insights into review studies within mathematics education. After searching Web of Science, we identified 259 review studies, revealing a significant increase in such studies over the last five years. Systematic reviews were the most prevalent type, followed by meta-analyses, generic literature reviews, and scoping reviews. On average, the review studies had a sample size of 99, with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines commonly employed. Despite certain studies offering nuanced distinctions among review types, ambiguity persisted. Only about a quarter of the studies explicitly reported employing specific theoretical frameworks (particularly, technology, knowledge, and competence models). Co-authored publications were most common within American institutions and the leading countries are the United States, Germany, China, Australia, and England in publishing most review studies. Educational review journals, educational psychology journals, special education journals, educational technology journals, and mathematics education journals provided platforms for review studies, and prominent research topics included digital technologies, teacher education, mathematics achievement, and learning disabilities. In this study, we synthesised a range of reviews to facilitate readers' comprehension of conceptual congruities and disparities across various review types, as well as to track current research trends. The results suggest that there is a need for discipline-specific standards and guidelines for different types of mathematics education reviews, which may lead to more high-quality review studies to enhance progress in mathematics education. [ABSTRACT FROM AUTHOR]

Background: Comprehensive quantitative evidence on the risk and protective factors for sudden infant death syndrome (SIDS) effects is lacking. We investigated the risk and protective factors related to SIDS. Methods: We conducted an umbrella review of meta-analyses of observational and interventional studies assessing SIDS-related factors. PubMed/MEDLINE, Embase, EBSCO, and Google Scholar were searched from inception until January 18, 2023. Data extraction, quality assessment, and certainty of evidence were assessed by using A Measurement Tool Assessment Systematic Reviews 2 following PRISMA guidelines. According to observational evidence, credibility was graded and classified by class and quality of evidence (CE; convincing, highly suggestive, suggestive, weak, or not significant). Our study protocol was registered with PROSPERO (CRD42023458696). The risk and protective factors related to SIDS are presented as equivalent odds ratios (eORs). Results: We identified eight original meta-analyses, including 152 original articles, covering 12 unique risk and protective factors for SIDS across 21 countries/regions and five continents. Several risk factors, including prenatal drug exposure [eOR = 7.84 (95% CI = 4.81–12.79), CE = highly suggestive], prenatal opioid exposure [9.55 (95% CI = 4.87–18.72), CE = suggestive], prenatal methadone exposure [9.52 (95% CI = 3.34–27.10), CE = weak], prenatal cocaine exposure [4.38 (95% CI = 1.95–9.86), CE = weak], prenatal maternal smoking [2.25 (95% CI = 1.95–2.60), CE = highly suggestive], postnatal maternal smoking [1.97 (95% CI = 1.75–2.22), CE = weak], bed sharing [2.89 (95% CI = 1.81–4.60), CE = weak], and infants found with heads covered by bedclothes after last sleep [11.01 (95% CI = 5.40–22.45), CE = suggestive], were identified. On the other hand, three protective factors, namely, breastfeeding [0.57 (95% CI = 0.39–0.83), CE = non-significant], supine sleeping position [0.48 (95% CI = 0.37–0.63), CE = suggestive], and pacifier use [0.44 (95% CI = 0.30–0.65), CE = weak], were also identified. Conclusions: Based on the evidence, we propose several risk and protective factors for SIDS. This study suggests the need for further studies on SIDS-related factors supported by weak credibility, no association, or a lack of adequate research. [ABSTRACT FROM AUTHOR]

Previous meta-analyses of multiple studies have suggested that dietary intake and blood concentrations of carotenoids, as well as dietary supplement of certain carotenoids, play a role in reducing the risk of cancer. However, the conclusions of these studies have been subject to controversy. We conducted an umbrella review of meta-analyses to comprehensively analyze and evaluate the evidence pertaining the association between carotenoids and cancer outcomes. We searched PubMed, Web of Science, Embase, and Cochrane Library databases of meta-analyses and systematic reviews up to June 2023. Our selection criteria encompassed meta-analyses of cohort and case-control studies, as well as randomized controlled clinical trials, which investigated the associations between carotenoids and cancer risk. We also determined the levels of evidence for these associations with AMSTAR 2 criteria. We included 51 eligible articles, including 198 meta-analyses for qualitative synthesis in the umbrella review. Despite the presence of moderate to high heterogeneity among the studies, dietary intake, supplementation, and blood concentrations of carotenoids were inversely associated with the risk of total cancer, and certain specific cancers of lung, digestive system, prostate, breast, head and neck, and others. Subgroup analysis also showed that individual carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein, zeaxanthin, and lycopene) offer certain protection against specific types of cancers. However, high doses of carotenoid supplements, especially β-carotene, significantly increased the risk of total cancer, lung cancer, and bladder cancer. Our umbrella meta-analysis supported that high intake of dietary carotenoids as a whole food approach could be more beneficial in reducing cancer risk. Concurrently, the findings suggest that the efficacy of single-carotenoid supplementation in cancer prevention remains a subject of controversy. [ABSTRACT FROM AUTHOR]

This umbrella review amalgamates the outcomes of economic evaluations pertaining to bariatric surgeries, pharmacotherapy, and gastric balloon for adult obesity treatment. Six databases were systematically searched. The inclusion criteria were established following the Patient/population Intervention Comparison and Outcomes (PICO) statement. Fifteen reviews met all the inclusion criteria. Eight studies focused on surgical interventions, four on pharmacotherapy, and three on both interventions. No systematic review of the economic evaluation of gastric balloons was identified. The majority of reviews advocated bariatric surgery as a cost-effective approach; however, there was discordance in the interpretation of pharmacological cost-effectiveness. Most of the economic evaluations were conducted from the payer and the healthcare system perspectives. We propose that future economic evaluations assessing weight loss interventions in adults adopt a societal perspective and longer-term time horizons. [ABSTRACT FROM AUTHOR]

Background: In this umbrella review, we systematically evaluated the evidence from meta-analyses and systematic reviews of maternal factors associated with low birth weight. Methods: PubMed, Scopus, and Web of Science were searched to identify all relevant published studies up to August 2023. We included all meta-analysis studies (based on cohort, case-control, cross-sectional studies) that examined the association between maternal factors (15 risk factors) and risk of LBW, regardless of publication date. A random-effects meta-analysis was conducted to estimate the summary effect size along with the 95% confidence interval (CI), 95% prediction interval, and heterogeneity (I2) in all meta-analyses. Hedges' g was used as the effect size metric. The effects of small studies and excess significance biases were assessed using funnel plots and the Egger's test, respectively. The methodological quality of the included studies was assessed using the AMSTAR 2 tool. Results: We included 13 systematic Review with 15 meta-analysis studies in our study based on the inclusion criteria. The following 13 maternal factors were identified as risk factors for low birth weight: crack/cocaine (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.26–3.52), infertility (OR 1.34, 95% CI 1.2–1.48), smoking (OR 2.00, 95% CI 1.76–2.28), periodontal disease (OR 2.41, 95% CI 1.67–3.47), depression (OR 1.84, 95% CI 1.34–2.53), anemia (OR 1.32, 95% CI 1.13–1.55), caffeine/coffee (OR 1.34, 95% CI 1.14–1.57), heavy physical workload (OR 1.87, 95% CI 1.00-3.47), lifting ≥ 11 kg (OR 1.59, 95% CI 1.02–2.48), underweight (OR 1.79, 95% CI 1.20–2.67), alcohol (OR 1.23, 95% CI 1.04–1.46), hypertension (OR 3.90, 95% CI 2.73–5.58), and hypothyroidism (OR 1.40, 95% CI 1.01–1.94). A significant negative association was also reported between antenatal care and low birth weight. Conclusions: This umbrella review identified drug use (such as crack/cocaine), infertility, smoking, periodontal disease, depression, caffeine and anemia as risk factors for low birth weight in pregnant women. These findings suggest that pregnant women can reduce the risk of low birth weight by maintaining good oral health, eating a healthy diet, managing stress and mental health, and avoiding smoking and drug use. [ABSTRACT FROM AUTHOR]

Background/Objectives: Liver Transplantation (LT) is the second most common solid organ transplantation. Medication adherence on LT patients is key to avoiding graft failure, mortality, and important quality of life losses. The aim of this study is to identify risk-factors for non-adherence to treatment of liver transplant patients according to reliable published evidence. Methods: An umbrella review within the context of adherence to immunosuppressant medication of LT patients, was conducted. The review was performed in accordance with the principles of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Results: A total of 11 articles were finally included for the review. Non-adherence factors were identified and allocated using the WHO classification of factors for non-adherence. Each of these groups contains a subset of factors that have been shown to influence adherence to medication, directly or indirectly, according to literature findings. Conclusions: The results of the review indicate that sociodemographic factors, factors related to the patient, factors related to the treatment, condition-related and health system-related factors are good categories of predictors for both adherence and non-adherence to immunosuppressive medication in LT patients. This list of factors may help physicians in the treating and recognizing of patients with a potential risk of non-adherence and it could help in the designing of new tools to better understand non-adherence after LT and targeted interventions to promote adherence of LT patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: There exists limited comprehensive evidence on the potential association between non-cardiac comorbidities and myocardial infarction (MI). Thus, we conducted an umbrella review of existing meta-analyses to provide a broad understanding of non-cardiac health outcomes associated with MI. MATERIALS AND METHODS: The primary focus on the prevalence of related health outcomes in patients with MI was systemically searched. Each original meta-analysis that was included had its methodological quality evaluated by a Measurement Tool Assessment Systematic Reviews 2 (AMSTAR2). To evaluate the certainty in the evidence for each outcome, we employed GRADE and the Joanna Briggs Institute Prevalence Critical Appraisal Tool. The protocol was registered in PROSPERO (CRD42023458642). RESULTS: We identified seven meta-analyses comprising 126 studies with 336,581 participants from 22 countries and five continents. The pooled prevalence of comorbidities in patients with MI was 39% anxiety [95% confidence interval (CI), 30-48; GRADE, very low certainty], 29% depression (95% CI, 23-36; very low certainty), 39% frailty (95% CI, 24-55; very low certainty), and 23% failure of returning to work (95% CI, 16-29; very low certainty). The diagnosis of MI was associated with an increased risk of cognitive impairment (odds ratio, 1.45; 95% CI, 1.10-1.92; moderate certainty). Among frail patients, MI was associated with an increased risk of major bleeding (relative risk, 1.93; 95% CI, 1.08-3.45; low certainty) and mortality (relative risk, 2.29; 95% CI, 1.48-3.53; moderate certainty). However, we did not find any evidence of cancer risk associated with the development of MI. CONCLUSIONS: Our umbrella meta-analysis provided comprehensive evidence of the association between MI and several non-cardiac health conditions. The robustness of our study is attributed to the integration of evidence across several studies, thus, these insights offer valuable treatment options for policymakers and physicians to develop personalized health strategies. [ABSTRACT FROM AUTHOR]

Background: Several published systematic reviews have drawn conflicting conclusions on the effect of abnormal body weight (i.e. being underweight, overweight or obese) on outcomes following stroke. The 'obesity paradox' seen in several diseases (wherein obesity, often associated with mortality and morbidity, appears to be protective and improve outcomes) may be evident after stroke, but inconsistent results of existing reviews, and the issue of being underweight, are worth investigating further. Aims: To better understand the impact of body weight on prognosis after stroke, we aimed to answer the following research question: What is the effect of abnormal body weight (underweight, overweight, or obesity) on mortality and functional recovery in adults after stroke? Summary of review: We conducted an umbrella review to synthesize existing evidence on the effects of abnormal body weight on stroke outcomes. We searched Cumulated Index to Nursing and Allied Health Literature (CINAHL) Complete, COCHRANE Database of Systematic Reviews, PubMed, Medline, PEDro, and EMBASE Classic + EMBASE, from inception until 28 February 2023. Seven systematic reviews (1,136,929 participants) from 184 primary studies (counting duplicates) were included. While the risk of mortality increases with being underweight (body mass index (BMI) < 18.5 kg/m2), excess body weight (being overweight (BMI = 25–29.9 kg/m2) or obese (BMI > 30 kg/m2)) is associated with reduced mortality. The impact of abnormal body weight on functional recovery is less clear; data from studies of being underweight are associated with poor functional outcomes while those from studies of excess body weight are inconclusive. Conclusion: Abnormal body weight effects post-stroke outcomes and should be considered in clinical decision-making, prognostic research, and clinical trials of rehabilitation interventions. The "obesity paradox" is evident after stroke, and excess body weight is associated with reduced mortality compared to normal body weight. It is recommended that body weight is routinely recorded for stroke patients, and further research, including well-designed cohort studies with reliable weight data, is needed to further investigate the impact of body weight and distribution on post-stroke outcomes. [ABSTRACT FROM AUTHOR]

Aim: Recurrent pregnancy loss (RPL) is a common clinical reproductive problem. With research advancements, an increasing number of studies have suggested that male factors play an important role in RPL. However, the evaluation results of male sperm quality in published meta‐analyses are inconsistent. We aimed to summarize the evidence of the association between semen factors and RPL and evaluate the level and validity of the evidence. Methods: We searched PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases for systematic reviews or meta‐analyses to evaluate the association between male semen parameters and RPL. The methodological quality of the included meta‐analyses was assessed, and data and evidence were re‐synthesized and stratified using a random‐effects model. Results: Seven meta‐analyses and nine semen parameters were included in the final analysis. The methodological quality of all publications was considered low or very low. There was highly suggestive evidence for the association between sperm DNA fragmentation (SDF), sperm progressive motility rate, and RPL (class II). The evidence level for the association between sperm concentration, normal sperm morphology, sperm deformity rate, total motility, and RPL was suggestive evidence (class III). The evidence level for the association between sperm volume and sperm count and RPL was weak (class IV). There was no significant association between sperm pH and RPL (class NS). Conclusions: Our results suggest level II evidence for the association between male SDF and RPL, while the evidence level for the association between conventional semen routine parameters and RPL was low (classes III and IV). [ABSTRACT FROM AUTHOR]

Objective: To prevent eating disorders in future physicians, this umbrella review and meta-analysis of previous meta-analyses estimates the prevalence of disordered eating (DE) among medical students worldwide and identifies key risk factors. Methods: Four databases were searched electronically between their inception and February 1, 2023. The search was later updated to December 31, 2023. Results: The search yielded prevalence rates for medical students who scored above established cutoffs on validated assessment measures for DE. These were computed to provide an overall pooled estimate. The data was taken from 2 previous reviews. Both these systematic reviews found a 15.1% (95% confidence interval [CI]: 14.7%-15.6%) prevalence rate of DE among medical students. The equivalent Hedges’ G=0.30 (95% CI: 0.29-0.31), the equivalent odds ratio=1.74 (95% CI: 1.71-1.77), I²=97.6%, and the excess of statistical significance is P=.001. The trim and fill adjusted effect size was 16.0% (95% CI: 14.0%-20.0%). Conclusion: Because eating disorders put students’ safety and well-being at risk and because the health of early-stage physicians is vital to the welfare of a country, early signs of disordered eating must become a priority of medical schools and a signal for effective prevention and intervention. The recommendation is to ensure supportive environments, provide easy access to effective care, and hold clear expectations for student eating behavior. [ABSTRACT FROM AUTHOR]

Background: An umbrella review was conducted to compare the effectiveness of extracorporeal shock wave therapy (ESWT) versus non-ESWT in the treatment of knee osteoarthritis (KOA). Materials and methods: Three databases including PubMed, Embase and Web of science were searched up to September 2023. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Metaanalysis of outcome indicators was performed using Revman 5.4 software. Results: A total of eight meta-analysis were included in this umbrella review. All meta-analysis were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and scored between 8 and 11. Compared to the sham group, the ESWT group showed better results in WOMAC (Western Ontario and McMaster Universities Arthritis Index) [mean difference (MD)= -2.94, 95% CI: -5.52, -0.37, P= 0.03, I²= 60%], Visual Analog Scale (VAS) (MD = - 2.0, 95% CI: - 2.5, - 1.5, P< 0.01, I²=0%), range of motion (ROM) (MD =17.55, 95% CI: 13.49, 21.61, P< 0.00001, I²=0%), and Lequesne index (MD = - 2.85, 95% CI: - 3.64, - 2.07, P<0.00001, I²=48%). Conclusion: Based on the results of our analysis, ESWT is now an effective therapy for improving pain and function in patients with KOA. [ABSTRACT FROM AUTHOR]

Background: Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN. Methods: A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares. Results: Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86–9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85–6.65), 3.58 (95% CI 2.75–4.66), and 2.85 (95% CI 2.13–3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17–0.37), ES: 0.25 (95% CI 0.13–0.50), ES: 0.26 (95% CI 0.17–0.41), and ES: 0.39 (0.28–0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P < 0.05). Conclusion: NGAL demonstrated superior diagnostic performance, exhibiting the highest AUC, positive likelihood ratio, and diagnostic odds ratio among biomarkers for CIN, followed by cystatin-C, and uKIM-1. These findings underscore the potential clinical utility of NGAL, cystatin-C and uKIM-1 in predicting and assessing CIN. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome and experience measures (PROMs and PREMs, respectively) are evidence-based, standardized questionnaires that can be used to capture patients' perspectives of their health and health care. While substantial investments have been made in the implementation of PROMs and PREMs, their use remains fragmented and limited in many settings. Analysis of multi-level barriers and enablers to the implementation of PROMs and PREMs has been hampered by the lack of use of state-of-the-art implementation science frameworks. This umbrella review aims to consolidate available evidence from existing quantitative, qualitative, and mixed-methods systematic and scoping reviews covering factors that influence the implementation of PROMs and PREMs in healthcare settings. Methods: An umbrella review of systematic and scoping reviews will be conducted following the guidelines of the Joanna Briggs Institute (JBI). Qualitative, quantitative, and mixed methods reviews of studies focusing on the implementation of PROMs and/or PREMs in all healthcare settings will be considered for inclusion. Eight bibliographical databases will be searched. All review steps will be conducted by two reviewers independently. Included reviews will be appraised and data will be extracted in four steps: (1) assessing the methodological quality of reviews using the JBI Critical Appraisal Checklist; (2) extracting data from included reviews; (3) theory-based coding of barriers and enablers using the Consolidated Framework for Implementation Research (CFIR) 2.0; and (4) identifying the barriers and enablers best supported by reviews using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. Findings will be presented in diagrammatic and tabular forms in a manner that aligns with the objective and scope of this umbrella review, along with a narrative summary. Discussion: This umbrella review of quantitative, qualitative, and mixed-methods systematic and scoping reviews will inform policymakers, researchers, managers, and clinicians regarding which factors hamper or enable the adoption and sustained use of PROMs and PREMs in healthcare settings, and the level of confidence in the evidence supporting these factors. Findings will orient the selection and adaptation of implementation strategies tailored to the factors identified. Systematic review registration: PROSPERO CRD42023421845. [ABSTRACT FROM AUTHOR]

Numerous studies have explored the use of repetitive Transcranial Magnetic Stimulation (rTMS) intervention in post-stroke dysphagia. The primary aim of this umbrella review was to appraise the methodological quality of systematic reviews (SRs), with and without meta-analyses (MAs), that synthesized the findings of randomized controlled trials (RCTs) exploring the effectiveness of rTMS in the management of dysphagia post-stroke. A secondary aim of was to evaluate the consistency and reliability of translational implications of rTMS for swallowing recovery after stroke across these SRs and MAs. We searched several databases from inception to the 14th of May 2023, to identify SRs and MAs that examined the effectiveness of rTMS in the management of dysphagia post-stroke. The methodological quality of the included studies was evaluated utilizing the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) instrument. To investigate the extent of literature overlap among the primary studies included in the SRs, the Graphical Overview of Evidence (GROOVE) was utilized. Of the 19 SRs that were identified, two studies received low quality ratings, while the rest (17) were rated with critically low quality based on the AMSTAR 2 rating. A high literature overlap across the SRs was observed. In all SRs and MAs reviewed, there was a consistent presence of at least some significant evidence supporting the effectiveness of rTMS in enhancing swallowing outcomes for individuals with dysphagia post-stroke, that is, all MAs reported at least a moderate overall effect in favor of rTMS (SMD range  =  [0.59, 6.23]). While rTMS shows promise for improving dysphagia post-stroke, the current evidence remains limited and inconclusive due to the methodological flaws observed in the published SRs and their respective MAs on the topic so far. Concerning the limitations of our study, language restrictions and methodological shortcomings may affect the generalizability of our findings. [ABSTRACT FROM AUTHOR]