Systematic Reviews

ObjectivesTo examine the prevalence of comparisons of surgery to drug regimens, the strength of evidence of such comparisons, and whether surgery or the drug intervention was favored. DesignSystematic review of systematic reviews (umbrella review) Data sourcesCochrane Database of Systematic Reviews (CDSR) Eligibility criteria and synthesis of resultsUsing the search term "surg*" in CDSR, we retrieved systematic reviews of surgical interventions. Abstracts were subsequently screened to find systematic reviews that aimed to compare surgical to drug interventions; and then, among them, those that included any randomized controlled trials (RCTs) for such comparisons. Trial results data were extracted manually and synthesized into random-effects meta-analyses. ResultsOverall, 188 systematic reviews intended to compare surgery versus drugs. Only 41 included data from at least one RCT (total, 165 RCTs with data) and covered a total of 103 different outcomes of various comparisons of surgery versus drugs. A GRADE assessment was performed by the Cochrane reviewers for 87 (83%) outcomes in the reviews, indicating the strength of evidence was high in 4 outcomes (4%), moderate in 22 (21%), low in 27 (26%) and very low in 33 (32%). Based on 95% confidence intervals, the surgical intervention was favored in 38/103 (37%), and the drugs were favored in 13/103 (13%) outcomes. Of the outcomes with high GRADE rating, only one showed conclusive superiority (sphincterotomy was better than medical therapy for anal fissure). Of the 22 outcomes with moderate GRADE rating, 6 (27%) were inconclusive, 14 (64%) were in favor of surgery, and 2 (9%) were in favor of drugs. ConclusionsThough the relative merits of surgical versus drug interventions are important to know for many diseases, high strength randomized evidence is rare. More randomized trials comparing surgery to drug interventions are needed. Protocol registrationhttps://osf.io/p9x3j FundingThe work of John Ioannidis has been funded by an unrestricted gift from Sue and Bob ODonnell. Anais Rameau is supported by a Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76 AG079040) from the National Institute on Aging and by the Bridge2AI award (OT2 OD032720) from the NIH Common Fund. Anirudh Saraswathula is supported by the National Institute on Deafness and Other Communication Disorders training grant 2T32DC000027. Financial disclosureAnais Rameau is a medical advisor for Perceptron Health, Inc. Summary boxes Section 1: What is already known on this topicO_LIMany conditions and diseases can be managed either with surgery or with drugs. Comparative effectiveness of different treatment options is important to know for shared decision-making. C_LI Section 2: What this study addsO_LIAn assessment of the entire Cochrane Database of Systematic Reviews found 188 reviews that intended to assess surgical versus drug interventions, but only 41 had at least one randomized trial. C_LIO_LIOnly four of the 103 assessed outcomes had high strength of evidence according to GRADE assessments. C_LIO_LIMore evidence is needed to compare the relative merits of surgical and drug interventions and sequestration of these major modes of interventions should be overcome in clinical trial agendas. C_LI

IntroductionLong COVID affects individuals labour market participation in many ways. While some cannot work at all, others may return to work (RTW) in a limited capacity. Determining what rehabilitation or related strategies are safe and effective for facilitating RTW is necessary. ObjectivesTo synthesize evidence on RTW interventions for people living with Long COVID and to identify promising interventions for enhancing work ability and RTW. MethodsWe followed Arksey & OMalleys methodology and the PRISMA extension for scoping reviews. Five electronic bibliographic databases and grey literature were searched. The included various study designs, such as randomized controlled trials (RCT), quasi-experimental designs, and observational studies. Two reviewers conducted screening and data extraction, with disagreements resolved through consensus. Intervention studies were categorized as promising (statistically significant RTW outcomes or [&ge;] 50% RTW), somewhat promising (20% to < 50% RTW), or not promising (non-statistically significant RTW outcomes or < 20% RTW). ResultsEleven recommendations and eleven intervention studies were identified. Of the intervention studies, 6 were cohort studies, 3 quasi-experimental studies, 1 RCT and 1 case report. Promising interventions included multimodal and interdisciplinary work-focused rehabilitation (1 article), psychoeducation, pacing, and breathing strategies (2 articles), shifting focus from symptom monitoring to optimizing functional outcomes (1 article), and enhanced external CounterPulsation (EECP) inflatable pressure to improve blood flow (1 article). ConclusionMany uncertainties remain regarding which RTW interventions are effective or the optimal characteristics of these interventions.

BackgroundHealthcare workplaces experience significant interpersonal conflicts affecting staff wellbeing, patient safety, and organizational performance. Traditional punitive approaches to conflict management often fail to address underlying issues, potentially perpetuating cycles of dysfunction. Restorative justice, emphasizing healing, accountability, and relationship repair over punishment, offers promising alternatives for healthcare conflict resolution. Despite growing implementation, systematic evidence synthesis regarding effectiveness, implementation factors, and outcomes remains absent. ObjectivesThis systematic review protocol aims to synthesize evidence on restorative justice approaches for managing workplace conflicts in healthcare settings, examining implementation processes, effectiveness, barriers, facilitators, and impacts on staff wellbeing, patient care, and organizational culture. MethodsFollowing PRISMA-P guidelines, we will search ten databases (PubMed, MEDLINE, CINAHL, PsycINFO, Embase, Scopus, Web of Science, Business Source Premier, Cochrane Library, and ProQuest) from inception to December 2025. The SPIDER framework guides eligibility criteria focusing on healthcare workers involved in restorative justice interventions, their experiences and outcomes across diverse healthcare contexts. Covidence will facilitate study screening and selection. Quality assessment will employ the Mixed Methods Appraisal Tool (MMAT), with risk of bias evaluated using appropriate domain-specific tools. Narrative synthesis and thematic analysis will integrate quantitative and qualitative findings. GRADE-CERQual will assess confidence in qualitative evidence synthesis. DiscussionThis protocol anticipates generating comprehensive evidence regarding restorative justice implementation models, effectiveness indicators, contextual factors influencing success, stakeholder experiences, and comparative advantages over traditional approaches. Evidence generated will inform policy development, implementation guidelines, and training programs for healthcare organizations seeking transformative conflict resolution approaches that prioritize healing, learning, and relationship restoration over punitive measures.

BackgroundLow back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little insight as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality for people with work disability and LBP and their functional capacity. MethodsWe performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether they do. Five initial theories about the relationship between income support systems and outcomes were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented with grey literature searches for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare and LBP. ResultsIncome support systems influence healthcare quality through funding restrictions, healthcare provider administrative burden, and allowing employers to select providers. They also influence worker functional capacity through the level of participation and financial incentives for employers, measures to prove the validity of the workers LBP, and certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition. DiscussionIncome support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory and administrative mechanisms. Research and policy design should consider how income support systems may indirectly influence workers with LBP via the workplace.

ObjectiveTo determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive. MethodsWe aggregated administrative claims data from seven Australian workers compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health, and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity. ResultsThe combined effect of step-downs was a 0.86 percentage point (95% CI -1.45 to -0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (I2 = 68%, p = .003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (-0.84, 95% CI -1.61 to -0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well. ConclusionsThe results suggest some workers compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative. Key messages1. What is already known about this subject?A number of workers compensation systems around the world reduce payments to injured workers after they have been in the system for several months. In Australia, where each state, territory, and Commonwealth system employs step-downs, the stated policy objective is to increase the rate of return to work through financial incentives. However, there is little empirical evidence to either support or reject this claim. 2. What are the new findings?The rate at which claimants exited workers compensation systems increased ahead of step-downs taking effect, suggesting an anticipatory effect. However, the effect was relatively small, changing the exit rate by less than a percentage point overall, with substantial heterogeneity between systems. 3. How might this impact on policy or clinical practice in the foreseeable future?While statistically significant, the findings suggest that step-downs provide workers compensation claimants little incentive to return to work. Policymakers may need to reconsider step-downs as a component of scheme design, or justify them according to their original purpose, which was to save costs.

BackgroundTrauma is one of the leading causes of death worldwide. Tranexamic acid (TXA) has shown effectiveness in reducing hemorrhage-related mortality in a hospital setting. However, its application in the prehospital setting still presents challenges. AimTo determine the efficacy and safety of TXA administered in the prehospital setting in trauma patients. MethodsA systematic review with meta-analysis was conducted. PRISMA guidelines were followed.Randomized clinical trials evaluating the administration of TXA in the prehospital setting in trauma patients aged 18 years or older were included. Studies were assessed by two reviewers independently. The GRADE approach was used to assess the quality of evidence and ROB2 to identify the risk of bias. Results were analyzed by meta-analysis, using fixed or random effects models, depending on the heterogeneity observed. ResultsA total of 979 records were identified; PubMed (149), Embase (565), Cochrane (29) and Scopus (236). Three studies were included. After analysis TXA reduced mortality in the first 24 hours (RR 0.74, 95% CI: 0.56-0.97; P = 0.03) and at 28 days (RR 0.82, 95% CI: 0.69-0.98; P = 0.03). No improvement in survival with favorable long-term functional outcome was observed (RR 1.11, 95% CI: 0.91-1.35; P = 0.29). No significant differences were found in adverse events such as deep vein thrombosis (RR 1.23, 95% CI: 0.96-1.58; P = 0.11), pulmonary embolism (RR 1.08, 95% CI: 0.76-1.53; P = 0.66) or myocardial infarction (RR 2.17, 95% CI: 0.75-6.31; P = 0.15). ConclusionsPrehospital TXA use in trauma patients reduces short-term mortality, mortality in the first 24 hours, and mortality at 28 days. In addition, it does not increase the risk of serious adverse events; deep vein thrombosis, pulmonary embolism, myocardial infarction, or ischemic stroke.

ObjectivesTo investigate the effectiveness of adding a brief vocational advice intervention to usual care in reducing the number of days absent from work over a period of 6 months in adults given a fit note by their general practice. DesignMulticentre, pragmatic, two parallel-arm, randomised controlled trial with health economic analyses and nested qualitative study. A computer-generated stratified block randomisation (ratio 1:1) was used to allocate arms. SettingParticipants will be recruited from general practices in the UK. Participants720 adults consulting in general practice, for any health condition, and receiving a fit note who have been absent from work for more than two-weeks but less than six months. InterventionsParticipants in the intervention arm will be offered usual care and vocational advice delivered by a Vocational Support Worker (VSW) remotely via phone or videoconferencing. Participants in the control arm will be offered usual care. Main outcome measureNumber of days off work over 6 months. Follow-up data collection is via questionnaires at 6 weeks and 6 months. ConclusionsThis paper presents the rationale, design and methods of the Work And Vocational advicE (WAVE) trial. The results of this trial will provide evidence to inform primary care practice and guide the development of services to provide support for patients with work absence. Trial registration: Clinical Trials: NCT04543097 Protocol number: Version 5.1

ObjectivesMost patients with health conditions necessitating time off work consult in primary care. Offering vocational advice (VA) early within this setting may help them to return-to-work (RTW) and reduce sickness absence. Previous research shows the benefits of VA interventions for musculoskeletal pain in primary care, but an intervention for a much broader primary care patient population has yet to be tested. The WAVE feasibility study tested patient identification and recruitment methods, explored participants experiences of being invited to the study and their experiences of receiving VA. DesignA mixed method, single arm feasibility study comprising both quantitative and qualitative analysis of recruitment and participation in the study. SettingPrimary care MethodsThe study included participant follow-up by fortnightly SMS text and 6-week questionnaire. Stop/go criteria focused on recruitment and intervention engagement. The semi-structured interviews explored participants experiences of recruitment and receipt and engagement with the intervention. ResultsNineteen participants were recruited (4.3% response rate). Identification of participants via retrospective fit-note searches was reasonably successful (13/19 (68%) identified), recruitment stop/go criteria were met with >50% of those eligible and expressing an interest recruited. The stop/go criterion for intervention engagement was met with 16/19 (86%) participants having at least one contact with a Vocational Support Worker (VSW). Five participants were interviewed; they reported positive experiences of recruitment and felt the VA intervention was acceptable. ConclusionThis study demonstrates that delivering VA in primary care is feasible and acceptable. To ensure a future trial is feasible, recruitment strategies and data collection methods require additional refinement. Trial registration: Clinical Trials: NCT04543097 Protocol number: Version 5.1 Article summary- This is the first study to test the feasibility of delivering a VA intervention to patients who present in primary care, regardless of their health condition. - The study used mixed methods to fully explore feasibility of the delivery of a full trial - The findings can usefully inform the development of the methods for a future trial to ensure that it meets the needs of participants in supporting them to return-to-work after a period of absence

ObjectivesTo develop an organising framework for healthcare decarbonisation research which goes beyond classification schemes based on Scope 1, 2 and 3 emissions or lists of loosely connected themes, and which is intended to support the coordination, funding and application of research into policy and practice. The organising framework should be focused on the NHS in England but enable application to healthcare systems more broadly. DesignAn exploratory manual (non-machine-led) classification study of over 160 research questions derived from a scoping review of 10 systematic reviews (118 screened), 13 stakeholder documents (35 key stakeholder websites searched), two research priority exercises, and four research funder sources (over 430 funding areas screened). The above and a further 21 sources were also used to identify areas without explicit research questions but of clear thematic relevance. SettingPrimarily high-income healthcare systems, with a focus on the NHS in England. ParticipantsNot applicable. Primary outcomeA multi-level thematic framework representing current and missing areas of research in healthcare decarbonisation. ResultsThe framework comprises six top-level themes, grouping 39 sub-themes at level two, and 86 sub-themes at level three. The top-level themes are: Natural resource use and sources of carbon; Healthcare contexts; Solutions; Stakeholders; Organisational levers for change; and Scientific measurement and theory (the "NHS-SOS framework"). ConclusionsThis framework offers a structured, empirically derived representation of the emerging field of healthcare decarbonisation research. It is intended as a living tool to support shared understanding, prioritisation and action, and to foster coherence in a currently fragmented research landscape. Article summaryO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIThe study used a transparent and structured process to derive themes from over 160 research questions, sourced from a diverse set of systematic reviews, stakeholder documents, research priority exercises, and funding calls. C_LIO_LIThe inductive approach respected the complexity, breadth and multiple perspectives inherent to healthcare decarbonisation research. C_LIO_LIThe study drew on a wide range of sources selected for conceptual and perspectival breadth but was nonetheless small relative to the volume of publications in the field. C_LIO_LIMany of the research questions were not explicitly stated in the source documents and had to be derived through interpretive analysis. This introduced a potential for bias, which was mitigated through a clearly documented and transparent process outlining how interpretations were made. C_LI

ObjectiveEvaluate the effect of risk communication tools on the understanding of statistical risk of complications occurring in patients undergoing a surgical or interventional procedure. Summary Background DataInformed consent is an essential process in clinical decision-making, through which healthcare providers educate patients about the benefits, risks and alternatives of a procedure. Numerical risk information is by nature probabilistic and difficult to communicate. Aids which support statistical risk communication and studies assessing their effectiveness are needed. MethodsA systematic search was performed across Medline, Embase, PsycINFO, Scopus and Web of Science until July 2021 with a repeated search in September 2022. Studies examining risk communication tools (e.g. informative leaflets, audio-video) in adults (age>16) patients undergoing a surgical or interventional procedure were included. Studies only assessing understanding of non-statistical aspects of the procedure were excluded. Both randomised control trials (RCTs) and observational studies were included. Cochrane risk-of-bias and the Newcastle-Ottawa Scale were used to assess the quality of studies. Due to heterogeneity of the studies, a narrative synthesis was performed (PROSPERO ID: CRD42022285789). ResultsA total of 4348 articles were identified and following abstract and full-text screening a total of 11 articles were included. 8 studies were RCTs and 3 were cross-sectional. The total number of adult patients was 1030. The most common risk communication tool used was additional written information (n=7). Of the 8 RCTs, 5 showed statistically significant improvements in the intervention group in outcomes relating to recall of statistical risk. Quality assessment of RCTs found some concerns with all studies. ConclusionsRisk communication tools appear to improve recall of statistical risk. Additional prospective trials are warranted which can compare various aids and determine the most effective method of improving patient understanding.

ImportanceGuidelines recommend parathyroidectomy for patients with primary hyperparathyroidism and osteoporosis. The use of surgery in patients with osteopenia is contested. ObjectiveTo evaluate the effect of parathyroidectomy on bone mineral density in patients with primary hyperparathyroidism and osteopenia. Data SourcesSystematic searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were conducted through November 2024. Study SelectionEligible studies included randomized controlled trials and cohort studies of adults with primary hyperparathyroidism who underwent parathyroidectomy and had dual X-ray absorptiometry bone mineral density measurements before and after surgery. Studies were required to report the proportion of patients with osteoporosis and/or osteopenia. Outcomes in secondary or tertiary hyperparathyroidism and hereditary syndromes were excluded. Of 642 unique records screened, 18 studies met inclusion criteria. Data Extraction and SynthesisTwo reviewers independently extracted study-level data. Main Outcomes and MeasuresSingle-arm random-effects meta-analysis was performed on mean bone mineral density change after parathyroidectomy at the lumbar spine, femoral neck, total hip and distal radius. ResultsPooled analysis demonstrated significant bone mineral density gains at the lumbar spine (+0.029 g/cm{superscript 2}; +3.38%), femoral neck (+0.022 g/cm{superscript 2}; +3.13%), and total hip (+0.021 g/cm{superscript 2}; +2.63%). Meta-regression showed that patients with osteopenia benefited comparably to those with osteoporosis. Conclusions and RelevanceParathyroidectomy is associated with improved bone mineral density at the lumbar spine, femoral neck and total hip in patients with primary hyperparathyroidism and osteopenia. Consideration can be given to the inclusion of osteopenia as an indication for surgery in future guidelines.

Background"Nature prescriptions" are gaining popularity as a form of social prescribing and in response to calls for sustainable healthcare. Our review and meta-analysis appraised evidence of effectiveness of nature prescriptions on various health outcomes. In doing so, we sought to determine the factors that are critical for the success of nature prescriptions, based on Social Cognitive Theory. MethodsThis is a scoping review with a nested meta-analysis for a subset of outcomes. Five databases were searched up to July 25, 2021. Randomised and non-randomised controlled studies featuring a nature prescription (i.e. an instruction or organised programme, by a health or social provider, to promote spending time in nature) are included. All health outcomes are eligible, but only key pre-specified outcomes are qualified for meta-analysis. Two reviewers independently conducted all steps of study selection; one reviewer conducted data collection and risk of bias assessment. Summary data was extracted from published reports for analysis. Random-effect models for meta-analysis were conducted using Review Manager 5.4.1. FindingsWe identified 86 unique studies (116 reports), of which 26 studies contributed data to meta-analysis. Compared to control, nature prescription programmes resulted in a greater reduction in systolic blood pressure (MD = -4{middle dot}9mmHg [-9{middle dot}6 to -0{middle dot}1], I2=65%) and diastolic blood pressure (MD = -3{middle dot}6mmHg [-7{middle dot}4 to 0{middle dot}1], I2=67%). They also had a moderate-to-large effect on depression scores (SMD=0{middle dot}5 [0{middle dot}2 to 0{middle dot}8], I2=79%) and anxiety score (SMD=0{middle dot}6 [0{middle dot}1 to 1{middle dot}2], I2=90%). Lastly, they resulted in a greater increase in daily step counts (MD = 900 steps [790-1010], I2=0%), but did not improve weekly time of moderate physical activities (MD = 25{middle dot}9 minutes [-10{middle dot}3 to 62{middle dot}1], I2=53%). Most studies have moderate to high risk of bias, principally due to non-blinding nature of the interventions, small sample size and lack of analysis plan to rule out risks of bias. InterpretationNature prescription programmes may provide cardiometabolic and mental health benefits and increase physical activity. Effective nature prescription programmes can select from a range of natural settings, activities and might be implemented via social and community channels, besides health providers. The Social Cognition Theory is useful in designing future nature prescription programmes. FundingThis work was supported by the Hort Frontiers Green Cities Fund, part of the Hort Frontiers strategic partnership initiative developed by Hort Innovation, with co-investment from the University of Wollongong (UOW) Faculty of Social Sciences, the UOW Global Challenges initiative and contributions from the Australian Government (project number #GC15005). T.A-B. was supported by a National Health and Medical Research Council Boosting Dementia Research Leader Fellowship (#1140317). X.F. was supported by a National Health and Medical Research Council Career Development Fellowship (#1148792). O_TEXTBOXPanel: Research in context Evidence before this studyExtensive evidence indicates contact with nature is associated with social, mental and physical health. However, little evidence exists on the effectiveness of nature prescriptions, which involve a health provider (e.g. general practitioner) recommending a patient to spend a fixed amount of time a week in a natural setting (e.g. a park). Other studies have attempted to evaluate the benefits of food prescription or green prescription programmes, which do not necessarily involve nature exposure. Only one systematic review on nature prescriptions has been conducted to date, which is a qualitative review without meta-analysis. The review concluded that the evidence (studies up to June 2019) was too sparse to discern any clear evidence of health impacts. There was insufficient information to assess the risk of bias or quality of evidence in the review. Moreover, the review included only nature prescriptions dispensed in outpatient settings, which left out prescription programmes implemented by other institutions, such as welfare centres, social services, universities or workplaces. Added value of this studyOur review is the first to provide comprehensive appraisal including meta-analysis of the effectiveness of nature prescription programs on multiple health outcomes. The scoping review identified a range of promising nature-based interventions that were dispensed outside the clinic setting and did not self-label as a nature prescription, but would be effective as one. The nested meta-analyses on key outcomes demonstrated positive benefits on blood pressure, symptoms of depression and anxiety, and physical activity levels. Implications of all the available evidenceOur findings suggest that an effective nature prescription programme can select from a range of natural settings, activities and can be implemented via social and community channels, in addition to health providers. In addition, we also demonstrated that the Social Cognition Theory framework is useful in designing future nature prescription programmes. C_TEXTBOX

IntroductionAccurate identification of study designs and risk of bias (RoB) assessment is crucial for evidence synthesis in research. However, mislabelling of case-control studies (CCS) is prevalent, leading to a downgraded quality of evidence. Large Language Models (LLMs), a form of artificial intelligence, have shown impressive performance in various medical tasks. Still, their utility and application in categorising study designs and assessing RoB needs to be further explored. This study will evaluate the performance of four publicly available LLMs (ChatGPT-3.5, ChatGPT-4, Claude 3 Sonnet, Claude 3 Opus) in accurately identifying CCS designs from the neurosurgical literature. Secondly, we will assess the human-LLM interrater agreement for RoB assessment of true CCS. MethodsWe identified thirty-four top-ranking neurosurgical-focused journals and searched them on PubMed/MEDLINE for manuscripts reported as CCS in the title/abstract. Human reviewers will independently assess study designs and RoB using the Newcastle-Ottawa Scale. The methods sections/full-text articles will be provided to LLMs to determine study designs and assess RoB. Cohens kappa will be used to evaluate human-human, human-LLM and LLM-LLM interrater agreement. Logistic regression will be used to assess study characteristics affecting performance. A p-value < 0.05 at a 95% confidence interval will be considered statistically significant. ConclusionIf the human-LLM agreement is high, LLMs could become valuable teaching and quality assurance tools for critical appraisal in neurosurgery and other medical fields. This study will contribute to validating LLMs for specialised scientific tasks in evidence synthesis. This could lead to reduced review costs, faster completion, standardisation, and minimal errors in evidence synthesis.

BackgroundBibliometric and Altmetric analyses provide important but alternative perspectives regarding research article impact. This study aimed to establish whether Altmetric Score (AS) was associated with citation rate, independent of bibliometrics. MethodCitations for a previously reported cohort of 100 most cited articles associated with the keyword "Surgery" (2018, Powell et al), were collected and a three-year interval Citation Gain (iCG) evaluated. Previous citation count, Citation Rate Index (CRI), AS, five-year Impact Factor, and Oxford Centre for Evidence Based Medicine (OCEBM) levels were used to classify citation rate prospect. ResultsDuring follow-up, the median iCG was 161 (IQR 83-281), with 73 and 62 articles receiving an increase in CRI and AS, respectively. Median CRI and AS increase were 2.8 (-0.1-7.7) and 3 (0-4), respectively. Receiver-Operator-Characteristic (ROC) analysis revealed that CRI (AUC 0.86 (95% CI 0.79-0.93), p<0.001) and AS (Area Under Curve (AUC) 0.65 (95% CI 0.55-0.76), p=0.008) were associated with higher iCG. AS critical threshold [&ge;] 2.0 was associated with better iCG when dichotomised at iCG median (OR=4.94, 95% CI 1.99-12.26, p=0.001) and iCG Upper Quartile (UQ, OR=4.13, 95% CI 1.60-10.66, p=0.003). Multivariable analysis identified that only CRI was independently associated with iCG when dichotomised at the median (OR 18.22, 95% CI 6.70-49.55, p<0.001) and UQ (OR 19.30, 95% CI 4.23-88.15, p<0.001). ConclusionCitation Rate Indices and Altmetric Scores are important predictors of interval Citation Gain, and better at predicting future citations than the historical and established Impact Factor and OCEBM quality of evidence descriptors.

AimThis systematic review and meta-analysis aimed to study the incidence of acute kidney injury after liver resection and to analyze various factors affecting it by metaregression analysis. MethodsThe study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (2020) and MOOSE guidelines. The meta-analysis was done using Review Manager 5.4 and the JASP Team (2020). JASP (Version 0.14.1)(University of Amsterdam). Weighted percentage incidence with 95% confidence intervals were used. Univariate metaregression was done by DerSimonian-Laird methods. Factors with a p-value less than 0.05 in the univariate metaregression model were entered in the multivariate metaregression model. Heterogeneity was assessed using the Higgins I2 test. The random-effects model was used in meta-analysis. ResultsTotal 14 studies including 15510 patients were included in the final analysis. 1247 patients developed Acute Kidney Injury. Weighted Acute kidney injury percentage after liver resection was 15% with a 95% confidence interval of 11%-19%. On univariate metaregression analysis major hepatectomy (p=0.001), Underlying cirrhosis of liver (p=0.031), AKIN definition used (0.017), male sex (p<0.001), open surgery (p=0.032), underlying diabetes (0.026). On multivariate metaregression analysis major hepatectomy (p=0.003), underlying cirrhosis (p<0.001), male sex (p<0.001), AKIN classification used for defining acute kidney injury (p < 0.001, independently predicted heterogeneity and hence acute kidney injury. ConclusionLiver resection is associated with a high incidence of acute kidney injury. Major hepatectomy, male sex, underlying cirrhosis were independently predicting acute kidney injury.

BackgroundPoor employee mental health and wellbeing are highly prevalent and costly. Time-related factors such as work intensification and perceptions of time poverty or pressure pose risks to employee health and wellbeing. While reviews suggest that there are positive associations between time management behavior and wellbeing, there is limited rigorous and systematic research examining the effectiveness of time management interventions on wellbeing in the workplace. A thorough review is needed to synthesize time management interventions and their effectiveness to promote employee mental health and wellbeing. MethodA systematic search will be conducted using the following databases: PsychINFO via OVID (1806-Present), Web of Science, Scopus via Elsevier (1976-Present), Academic Search Complete (EBSCO), Cochrane Library via Wiley (1992-Present), and MEDLINE via OVID (1946-Present). The review will include experimental and quasi-experimental studies that evaluate the effects of time management interventions on wellbeing outcomes on healthy adults in a workplace context. Only studies in English will be included. Two authors will independently perform the literature search, record screening, data extraction, and quality assessment of each study included in the systematic review and meta-analysis. Data will be critically appraised using the Cochrane risk-of-bias tools. Depending on the data, a meta-analysis or a narrative synthesis will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the development of this protocol. The protocol has been registered in PROSPERO (CRD4202125715). DiscussionThis review will provide systematic evidence on the effects of time management interventions on wellbeing outcomes in the workplace. It will contribute to our understanding of how time management approaches may help to address growing concerns for employee mental health and wellbeing.

ObjectiveUp to 86% of musicians experience playing-related musculoskeletal problems (PRMPs). Joint hypermobility (JH), which affects up to 34% of the population, may be a risk factor for such injuries, however, research on this topic is limited. The aims in this scoping review are to: (1) map information in existing literature on the relationship between JH and PRMPs in instrumental musicians, (2) identify subpopulations at risk of JH-related injuries, and (3) map supportive strategies used to accommodate hypermobile instrumentalists. DesignThe review was conducted following JBI methodology and adapted for a masters thesis. Searches were performed in MEDLINE, Music Index, SPORTDiscus, and gray literature databases, using keywords related to "instrumental musicians" and "hypermobility," resulting in 1570 sources. ResultsOf 165 relevant sources, 79 included original data on hypermobility, with only 30 primarily focused on JH. Most sources were published among populations primarily of European descent and adults ages 18-40 in professional or post-secondary classical settings. Research gaps identified include studies addressing hormonal influences on joint laxity, non-European populations, children, amateur musicians, and neurodivergent individuals. Sources containing original JH information consisted of 45% empirical studies (mostly prevalence) and 55% anecdotal reports. In 72% of all sources, authors concluded JH negatively impacts musicians. ConclusionsInconsistent results among empirical studies and incongruences between results and anecdotal evidence are indicative of methodological weaknesses. Limitations in measurement tools were noted, affecting study design and data interpretation. Future researchers should conduct qualitative research to capture experiences of hypermobile musicians to inform study design. They should expand quantitative methods, particularly longitudinal and randomized controlled trials, and incorporate sensitive, joint-specific assessments. Training for healthcare professionals, musicians, and music teachers should include JH and health impacts on musicians to ensure accurate research design and interpretation. RegistratioThe scoping review protocol (https://osf.io/c5rzn) was previously registered and published on the Open Science Framework (OSF) along with all official documents, search query strings, and raw data (https://osf.io/6jynk/). STRENTHS AND LIMITATIONS OF THIS STUDYO_LIThis is the first review focused on instrumental musicians with joint hypermobility. C_LIO_LIA thorough and detailed search strategy was developed with the assistance of expert research librarians and the review was conducted in accordance with the JBI scoping review manual and PRISMA-Scr guidelines, except where noted. C_LIO_LIThe review was conducted as a masters thesis requirement for Radford University. Due to time and resource constraints, only one reviewer was involved in data extraction and analysis with oversight of a research committee. C_LIO_LIAs is standard with scoping reviews, sources were not evaluated for quality, therefore, conclusions cannot be generalized. C_LI

ObjectiveTo describe the surgical journal position statement on data-sharing policies (primary objective) and to describe the other features of their research transparency promotion. MethodsOnly "SURGICAL" journals with an impact factor superior to 2 (Web of Science) were eligible for the study. They were not included if there were no explicit instructions for clinical trial publication in the instructions for authors and if there were no RCT published between January 2016 and January 2019. The primary outcome was the existence of a data-sharing policy in the instructions for authors. Details on research transparency promotion were also collected, namely the existence of a "prospective registration of clinical trials requirement" policy; a "COIs" disclosure requirement and a specific reference to reporting guidelines such as CONSORT for RCT. ResultsAmong the 87 surgical journals eligible, 82 (94%) were included in the analysis: 67 (77%) had explicit instructions for RCT and of the remaining, 15 (17.2%) had published at least one RCT between 2016-2019. The median impact factor was 2.98 [IQR=2.48-3.77] and in 2016 and 2017, the journals published a median of 11.5 RCT [IQR=5-20.75]. Data-sharing statement instructions (primary outcome) were ICMJE-compliant in four cases (4.88%), weaker in 45.12% (n=37) and inexistent in 50% (n=41) of the journals. As for data-sharing statements, no association was found between journal characteristics and the existence of data-sharing policies (ICMJE-compliant or weaker). A "prospective registration of clinical trials requirement" was associated with ICMJE allusion or affiliation and higher impact factors. Journals with specific RCT instructions in their OIA and journals referenced on the ICMJE website more frequently mandated the use of CONSORT guidelines. ConclusionResearch transparency promotion is still limited in surgical journals. Uniformization of journal requirements vis-a-vis ICMJE guidelines could be a first step forward for research transparency promotion in surgery.

BackgroundThe COVID-19 pandemic has led to unprecedented demand for personal protective equipment. Shortages of surgical masks and filtering facepiece respirators has led to the extended use or re-use of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices has been questioned. ObjectivesTo summarise guidance and synthesise systematic review evidence on extended use, re-use or reprocessing of single-use surgical masks or filtering facepiece respirators. MethodsA targeted search of the World Health Organization, European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites was conducted to identify guidance. Four databases (Medline, Pubmed, Epistemonikos, Cochrane Database of Systematic Reviews) and three preprint repositories (Litcovid, MedRxiv and Open Science Framework) were searched for relevant systematic reviews. Record screening and data extraction was conducted by two reviewers. Quality of included systematic reviews was appraised using the AMSTAR-2 checklist. Findings were integrated and narratively synthesised to highlight the extent to which key claims in guidance documents were supported by research evidence. ResultsSix guidance documents were identified. All note that extended use or re-use of single-use surgical masks and respirators (with or without reprocessing) should be considered only in situations of critical shortage. Extended use was generally favoured over re-use because of reduced risk of contact transmission. Four high-quality systematic reviews were included: three focused on reprocessing (decontamination) of N95 respirators and one focused on reprocessing of surgical masks. There was limited evidence on the impact of extended use on masks and respirators. Vaporised hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. ConclusionsThere is limited evidence on the impact of extended use and re-use of surgical masks and respirators. Where extended use or re-use is being practiced, healthcare organisations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.

ObjectivesChest Xray (CXR) is widely used for silicosis diagnosis, despite concerns regarding sensitivity. We investigated the diagnostic accuracy of CXR for silicosis screening compared to computed tomography (CT), high-resolution CT (HRCT) and autopsy, and modelled the relationship between CXR sensitivity and disease severity. MethodsMedline, Embase, Scopus, and Web of Science databases were searched on 2nd July 2024 (Prospero registration: CRD42024513830). Meta-analyses were performed by reference standard and at increasing reference test severity cut-offs. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool assessed risk of bias. In scenarios of fixed and relative sensitivity, according to disease severity, we estimated missed silicosis cases and the number needed to screen (NNS) in hypothetical populations of low (5%), medium (15%) and high (30%) silicosis prevalence. ResultsTwenty studies included 2156 participants and 1105 silicosis cases. CXR had moderate sensitivity (0.76; 95% confidence interval (CI): 0.63-0.86, I2=84%) and high specificity (0.89, 95% CI: 0.77-0.95, I2=57%) compared to HRCT in 12 studies, and low sensitivity (0.50, 95% CI: 0.45-0.55, I2=0%) and high specificity (0.91, 95% CI: 0.87-0.93, I2=20%) compared to autopsy in two studies. CXR sensitivity increased with higher reference test severity cut-offs. Clinically relevant numbers of cases were missed in fixed and relative sensitivity scenarios; increased prevalence and less severe disease resulted in more missed cases and a lower NNS. ConclusionsSilicosis severity and reference test type both plausibly influence CXR sensitivity. Assuming either fixed or relative sensitivity results in missed silicosis cases. Judicious HRCT screening is likely to improve case detection. What is already known on this topicIt is widely understood that Chest Xray (CXR) underdiagnoses silicosis compared to more accurate methods, such as high resolution computed tomography (HRCT) and autopsy. What this study addsOur systematic review and meta-analysis demonstrated that the sensitivity of CXR was lowest when compared to autopsy (50%), followed by HRCT (76%). This difference may be explained by the increased accuracy of autopsy as a reference test. Another potential explanation for differences between study results could be that - because severe silicosis is more easily diagnosed by CXR - studies with a higher proportion of severe disease recorded higher sensitivity results. Importantly, regardless of whether differences between studies are explained by different reference test modalities or the proportion of severe disease, when modelled among a population of silica-exposed workers, many silicosis cases are missed. How this study might affect research, practice or policyThis study suggests the careful implementation of HRCT screening for silicosis would improve case detection.