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Background: The limitations of the traditional TNM system have spurred interest in multivariable models for personalized prognostication in laryngeal and hypopharyngeal cancers (LSCC/HPSCC). However, the performance of these models depends on the quality of data and modelling methodology, affecting their potential for clinical adoption. This systematic review and meta-analysis (SR-MA) evaluated clinical predictive models (CPMs) for recurrence and survival in treated LSCC/HPSCC. We assessed models' characteristics and methodologies, as well as performance, risk of bias (RoB), and applicability. Methods: Literature searches were conducted in MEDLINE (OVID), Embase (OVID) and IEEE databases from January 2005 to November 2023. The search algorithm used comprehensive text word and index term combinations without language or publication type restrictions. Independent reviewers screened titles and abstracts using a predefined Population, Index, Comparator, Outcomes, Timing and Setting (PICOTS) framework. We included externally validated (EV) multivariable models, with at least one clinical predictor, that provided recurrence or survival predictions. The SR-MA followed PRISMA reporting guidelines, and PROBAST framework for RoB assessment. Model discrimination was assessed using C-index/AUC, and was presented for all models using forest plots. MA was only performed for models that were externally validated in two or more cohorts, using random-effects model. The main outcomes were model discrimination and calibration measures for survival (OS) and/or local recurrence (LR) prediction. All measures and assessments were preplanned prior to data collection. Results: The SR-MA identified 11 models, reported in 16 studies. Seven models for OS showed good discrimination on development, with only one excelling (C-index >0.9), and three had weak or poor discrimination. Inclusion of a radiomics score as a model parameter achieved relatively better performance. Most models had poor generalisability, demonstrated by worse discrimination performance on EV, but they still outperformed the TNM system. Only two models met the criteria for MA, with pooled EV AUCs 0.73 (95% CI 0.71-0.76) and 0.67 (95% CI 0.6-0.74). RoB was high for all models, particularly in the analysis domain. Conclusions: This review highlighted the shortcomings of currently available models, while emphasizing the need for rigorous independent evaluations. Despite the proliferation of models, most exhibited methodological limitations and bias. Currently, no models can confidently be recommended for routine clinical use. Systematic review registration: https://www.crd.york.ac.uk/prospero/display%5frecord.php?ID=CRD42021248762 , identifier CRD42021248762. [ABSTRACT FROM AUTHOR]

Background: The traditional cancer follow‐up (FU) model for cancer survivors is by scheduled clinic appointments; however, this is not tailored to patient needs and is becoming unsustainable. Patient‐initiated follow‐up (PIFU) may be a more effective and flexible alternative. This systematic review aims to analyse all existing evidence from randomised controlled trials (RCTs) on the effectiveness of PIFU compared with other FU models that include routinely scheduled appointments in adults who have been treated with curative intent for any type of cancer. Methods: Standard systematic review methodology aimed at limiting bias was used for study identification, selection and data extraction. MEDLINE, Embase, CINAHL, the Cochrane Database of Systematic Reviews and Epistemonikos were searched for systematic reviews to March 2022, and Cochrane CENTRAL was searched for RCTs from 2018 (April 2023). Ongoing trial registers were searched (WHO ICTRP, ClinicalTrials.gov, April 2023). Eligible studies were randomised controlled trials comparing PIFU with an alternative FU model in adult cancer survivors. Risk of bias assessment was via the Cochrane risk of bias tool‐2. Meta‐analysis was precluded by clinical heterogeneity and results were reported narratively. Results: Ten RCTs were included (six breast, two colorectal, one endometrial cancer and one melanoma, total n = 1754); all studies had risk of bias concerns, particularly relating to how missing data were handled, and populations were unlikely to be representative. Limited findings in breast cancer suggested that type of FU does not affect recurrence detection or patient‐related outcomes, while PIFU may reduce the number of clinic visits. Adding patient‐led surveillance to routine FU may increase melanoma detection. Evidence for other types of cancer is too limited to draw firm conclusions. Conclusions: PIFU may be a viable FU model in breast cancer, but further research is needed for other types of cancer and on long‐term outcomes. A protocol was registered with PROSPERO (CRD42020181424). [ABSTRACT FROM AUTHOR]

Background: Current follow‐up models in cancer are seen to be unsustainable and inflexible, and there is growing interest in alternative models, such as patient‐initiated follow‐up (PIFU). It is therefore important to understand whether PIFU is acceptable to patients and healthcare professionals (HCPs). Methods: Standard systematic review methodology aimed at limiting bias was used for study identification (to January 2022), selection and data extraction. Thematic synthesis was undertaken for qualitative data, and survey findings were tabulated and described. Results: Nine qualitative studies and 22 surveys were included, mainly in breast and endometrial cancer. Women treated for breast or endometrial cancer and HCPs were mostly supportive of PIFU. Facilitators for PIFU included convenience, control over own health and avoidance of anxiety‐inducing clinic appointments. Barriers included loss of reassurance from scheduled visits and lack of confidence in self‐management. HCPs were supportive of PIFU but concerned about resistance to change, unsuitability of PIFU for some patients and costs. Conclusion: PIFU is viewed mostly positively by women treated for breast or endometrial cancer, and by HCPs, but further evidence is needed from a wider range of cancers, men, and more representative samples. A protocol was registered with PROSPERO (CRD42020181412). [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a chronic disease associated with recurring exacerbations, which influence morbidity and mortality for the patient, while placing significant resource burdens on healthcare systems. Non-invasive ventilation (NIV) in a domiciliary setting can help prevent admissions, but the economic evidence to support NIV use is limited.Methods: A Markov model-based cost-utility analysis from the UK National Health Service perspective compared the cost-effectiveness of domiciliary NIV with usual care for two end-stage COPD populations; a stable COPD population commencing treatment with no recent hospital admission; and a posthospital population starting treatment following admission to hospital for an exacerbation. Hospitalisation rates in patients receiving domiciliary NIV compared with usual care were derived from randomised controlled studies in a recent systematic review. Other model parameters were updated with recent evidence.Results: At the threshold of £20 000 per quality-adjusted life-year (QALY) domiciliary NIV is 99.9% likely cost-effective in a posthospital population, but unlikely (4%) to be cost-effective in stable populations. The incremental cost-effective ratio (ICER) was £11 318/QALY gained in the posthospital population and £27 380/QALY gained in the stable population. Cost-effectiveness estimates were sensitive to longer-term readmission and mortality risks, and duration of benefit from NIV. Indeed, for stable Global Initiative for Chronic Obstructive Lung Disease (GOLD) for stage 4 patients, or with higher mortality and exacerbation risks, ICERs were close to the £20 000/QALY threshold.Conclusion: Domiciliary NIV is likely cost-effective for posthospitalised patients, with uncertainty around the cost-effectiveness of domiciliary NIV in stable patients with COPD on which further research should focus. [ABSTRACT FROM AUTHOR]

Abstract Background Conduct problems are common, disabling and costly. The prognosis for children with conduct problems is poor, with outcomes in adulthood including criminal behaviour, alcoholism, drug abuse, domestic violence, child abuse and a range of psychiatric disorders. There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems in a number of countries over the past 10 years. Existing reviews of parent training have methodological limitations such as inclusion of non-randomised studies, the absence of investigation for heterogeneity prior to meta-analysis or failure to report confidence intervals. The objective of the current study was to systematically review randomised controlled trials of parenting programmes for the treatment of children with conduct problems. Methods Standard systematic review methods were followed including duplicate inclusion decisions, data extraction and quality assessment. Twenty electronic databases from the fields of medicine, psychology, social science and education were comprehensively searched for RCTs and systematic reviews to February 2006. Inclusion criteria were: randomised controlled trial; of structured, repeatable parenting programmes; for parents/carers of children up to the age of 18 with a conduct problem; and at least one measure of child behaviour. Meta-analysis and qualitative synthesis were used to summarise included studies. Results 57 RCTs were included. Studies were small with an average group size of 21. Meta-analyses using both parent (SMD -0.67; 95% CI: -0.91, -0.42) and independent (SMD -0.44; 95% CI: -0.66, -0.23) reports of outcome showed significant differences favouring the intervention group. There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes. Conclusion Parenting programmes are an effective treatment for children with conduct problems. The relative effectiveness of different parenting programmes requires further research.

Abstract Background Allergies cause a considerable burden to both sufferers and the National Health Service. There is growing interest in acupuncture as a treatment for a range of conditions. Since acupuncture may modulate the immune system it could be a useful treatment for allergic rhinitis (AR) sufferers. We therefore assessed the evidence for the clinical effectiveness of acupuncture in patients with AR by performing a systematic review of the literature. Methods Searches (to 2007) were conducted in all major databases for randomised controlled trials (RCTs) evaluating the clinical effectiveness of acupuncture in the treatment of AR. No limits were placed on language. Studies were included if they compared acupuncture to a sham or inactive acupuncture treatment (placebo) with or without standard care. Meta-analysis was performed where feasible. Results Seven relevant RCTs were included after screening and application of inclusion and exclusion criteria. The trials were generally of poor quality as assessed by a modified Jadad scale, with the exception of two studies which scored highly. A wide variety of outcomes was measured but most assessed symptom severity on a visual analogue scale. A meta-analysis failed to show any summary benefits of acupuncture treatment for symptom severity scores or serum IgE measures which could not have been accounted for by chance alone. Acupuncture was not associated with any additional adverse events in the trials. Conclusion There is currently insufficient evidence to support or refute the use of acupuncture in patients with AR. A large well conducted RCT, which overcomes identified methodological problems in the existing RCTs, would be required to resolve this question.