METHODS: PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wan fang, and VIP databases were searched for studies published from inception to 2023, without language restrictions. Observational studies were included in this systematic review that analyzed risk factors for accidental falls in pre-frail older adults. The NOS scale was used to evaluate the quality of cohort studies and case-control studies, while the AHRQ scale was used to evaluate the quality of the cross-sectional study. We utilized odds ratios (OR) and their corresponding 95 % confidence intervals (CI) to describe the statistical indicators. OR and 95 % CI values were directly extracted and organized in Excel. In cases where OR and CI values were not directly available, we extracted β and p values, calculated Exp using functions, and subsequently derived OR and 95 % CI using formulas. Finally, data pertaining to each risk factor were incorporated into RevMan 5.4 software for statistical analysis and effect size synthesis. We performed tests for heterogeneity and evaluated publication bias.
RESULTS: A total of 14,370 studies were initially identified, and 26 studies were included in the systematic review. Among these studies, 14 were of high quality, while the remaining 12 were of moderate quality. A total of 16 risk factors were identified as potential risk factors for falls in pre-frail older adults. Significant risk factors were peripheral neuropathy(OR = 3.18, 95 %CI:3.02-3.35), decreased gait speed(OR = 1.90, 95 %CI:1.60-2.27), decreased ability to perform activities of daily living(OR = 1.57, 95 % CI:1.42-1.75), grip strength decreases(OR = 1.53, 95 % CI:1.17-2.00), gender (female)(OR = 1.51, 95 % CI:1.39-1.64), pain(OR = 1.47, 95 %CI:1.41-1.54), history of falls(OR = 1.20, 95 %CI:1.13-1.28) and age(OR = 1.10, 95 %CI:1.07-1.14).
CONCLUSIONS: The occurrence of falls in pre-frail older adults is associated with multiple risk factors. These risk factors can provide clinical nursing staff with specific focal points for monitoring this population and devising targeted fall prevention measures, with the aim of reducing the incidence of falls in pre-frail older adults.
REGISTRATION: The systematic review was registered on the International Prospective Register of Systematic Review (CRD42023450670).
MATERIALS AND METHODS: Following the PRISMA guidelines, a comprehensive literature search was conducted across Scopus and Web of Science, focusing on publications from January 2020 to May 2024. After rigorous screening and quality assessment, 69 studies were selected for in-depth analysis.
RESULTS: The review identified critical gaps in the application of XAI within cancer care, notably the exclusion of clinicians in 83% of studies, which raises concerns about real-world applicability and may lead to explanations that are technically sound but clinically irrelevant. Additionally, 87% of studies lacked rigorous evaluation of XAI explanations, compromising their reliability in clinical practice. The dominance of post-hoc visual methods like SHAP, LIME and Grad-CAM reflects a trend toward explanations that may be inherently flawed due to specific input perturbations and simplifying assumptions. The lack of formal evaluation metrics and standardization constrains broader XAI adoption in clinical settings, creating a disconnect between AI development and clinical integration. Moreover, translating XAI insights into actionable clinical decisions remains challenging due to the absence of clear guidelines for integrating these tools into clinical workflows.
CONCLUSION: This review highlights the need for greater clinician involvement, standardized XAI evaluation metrics, clinician-centric interfaces, context-aware XAI systems, and frameworks for integrating XAI into clinical workflows for informed clinical decision-making and improved outcomes in cancer care.
OBJECTIVES: This review evaluated the effectiveness of strategies for enhancing ADR reporting by healthcare professionals (HCPs).
METHODS: This systematic review was conducted following the Cochrane and the PRISMA guidelines. Five international databases were searched from inception to December 2023 and updated search to September 2024. Randomized clinical controlled trials (RCTs) and non-RCTs on enhancing ADR reporting were included. The primary outcomes were the number of overall ADR and high-quality ADR reports. Study quality was assessed using the EPOC risk of bias (ROB), and ROBIN-I for RCT, and non-RCT. All data were evaluated using a random-effects model, and heterogeneity was assessed using I2 statistic and chi-squared tests.
RESULTS: From 1,672 studies, 13 studies (10 RCTs, and 3 non-RCTs) with 28,116 participants were included. Two of 10 RCTs had low ROB while the remaining were judged as unclear and moderate ROB. Most studies were in high-income countries, and the main strategy was educating HCPs through workshops. Meta-analysis showed significant increases in overall ADR reporting through educating HCPs with a rate ratio (RR) of 5.09 (95%CI: 3.36-7.71, I2=84.5%, low certainty), and in high-quality reporting with 1.31 (95%CI:1.09-1.58, I2=0.0%, moderate certainty). Subgroup analysis indicated that educating HCPs through face-to-face workshops combined with the Tawai app (RR:10.5, 95%CI:8.74-12.61), a face-to-face workshop alone (RR:6.69, 95%CI:5.43-8.25, I2=0.0%), and repeated telephone (RR:2.59, 95%CI:1.75-3.84, I2=8.8%) significantly increased the overall number of ADR reports with moderate certainty. Email or letter communications showed no significant effect.
CONCLUSION: Educating HCPs via interactive strategies like face-to-face workshops with or without a mobile app and repeated phone calls improved ADR reporting. However, long-term, high-quality studies are needed to confirm these findings before recommending widespread implementation in clinical practice, especially in LMICs.
OBJECTIVE: This research aimed to investigate the effects of the genetic polymorphisms CYP3A4*1B and CYP3A5*3 on atorvastatin treatment in Egyptians.
METHODS: In this prospective cohort study, 100 subjects were genotyped for these SNPs. All participants were screened for serum lipid profiles, liver enzymes, total bilirubin (TB), and creatine kinase (CK) before and after 40 mg postatorvastatin therapy. Atorvastatin plasma levels were assessed posttreatment; atorvastatin pharmacokinetics were evaluated in five carriers of the CYP3A4*1B (T/T) and CYP3A5*3 (C/C) genotypes.
RESULTS: The allele frequencies of the CYP3A4*1B and CYP3A5*3 SNPs were 86% and 83%, respectively. The CYP3A4*1B (T/T) and CYP3A5*3 (C/C) genotypes significantly improved the serum triglyceride (TG) level (P
METHODS: A total of 102 school-aged children with obesity (54 girls and 48 boys) aged 8-16 years completed a 16-week school-based lifestyle modification intervention program, MyBFF@school Phase I. The intervention consisted of physical activity, healthy eating promotion, and psychological empowerment. MHO and MUO statuses were defined based on the 2018 consensus-based criteria. Fasting venous blood collection, body composition measurement, clinical assessment and physical fitness testing were conducted at baseline and at the end of week 16.
RESULTS: After the intervention, the CRFs of the children with MUO improved with significant decreases in systolic (p
METHODS: Two hundred seventy-three of the 289 preclinical medical students who were invited to participate responded to this 2022 study. We used validated questionnaires to measure engagement with reflection and perceived self-efficacy for clinical skills, conducting hierarchical multiple linear regression for analysis. Thirteen students participated in semi-structured interviews and focus groups, which were analysed via thematic analysis.
RESULTS: While statistical analysis showed no significant effects of engaging with reflection on clinical skill self-efficacy, thematic analysis suggested that students perceived the opposite. The themes through which reflection affected self-efficacy were by 'evaluation of performances' against expected outcomes, 'familiarisation and understanding of skills', by 'transforming personal mindsets' and allowing students to 'connect to their emotions'.
CONCLUSION: This study suggests that engaging with reflection can positively or negatively affect self-efficacy for clinical skills, depending on students' attitudes towards reflective practice. Solely engaging with reflection is insufficient to alter self-efficacy beliefs and should be considered alongside personal factors including the individual's mindset and perceived need for reflection. The medical educator's role in facilitating reflection is important, enabling students to reap the benefits of this practice.