Browse publications by year: 2025

  1. Maharajan MK, Sivapalan S, Rajiah K
    Curr Pharm Teach Learn, 2025 Jan 20;17(4):102280.
    PMID: 39836992 DOI: 10.1016/j.cptl.2025.102280
    INTRODUCTION: The concept of "Students as Partners" (SaP) in curriculum design and pedagogy marks a significant shift towards relational pedagogical approaches in higher education. This study explored pharmacy students' perceptions of the SaP approach, focusing on their involvement in curriculum design and the perceived benefits and challenges of such partnerships.

    METHODS: A qualitative research design was employed, utilising one-on-one interviews with pharmacy students at a university in Malaysia. Participants were selected through purposive and snowball sampling. Data were collected using a semi-structured interview guide and analysed using thematic analysis.

    RESULTS: Thematic analysis revealed five core themes: student involvement in curriculum design, perceived benefits in students as partners, challenges in active learning environments, suggestions to improve relational pedagogy, and empowerment through student involvement in curriculum design. Students mentioned that the relationship as partners with educators will be beneficial and mentioned challenges, such as hierarchical barriers and communication issues. They suggested increased training and support, more frequent feedback mechanisms, and clearer communication channels to foster effective partnerships.

    CONCLUSION: Students perceived that their engagement could lead to significant changes in their academic journeys. This participatory approach aligns with outcome-based educational goals and enhances the overall learning experience by making the content more relevant to students' needs and aspirations. The SaP approach has transformative potential in higher education.

  2. Li J, Xie Z, Fu Y
    J Environ Manage, 2025 Feb;374:124057.
    PMID: 39837146 DOI: 10.1016/j.jenvman.2025.124057
    Climate change poses significant challenges, making low-carbon development an essential global trend. In this context, building a green brand has become a critical strategy for companies to enhance consumer loyalty and maintain competitiveness. This study explores how the digital economy shapes sports brand loyalty, focusing on a dataset of Chinese A-share listed companies from Shanghai and Shenzhen, spanning 2011 to 2020. The findings suggest that the digital economy can significantly foster sports brand loyalty. In this process, the digital transformation of enterprises plays a mediating role. This effect is more pronounced in southern regions, non-resource cities and regions actively implementing the Broadband China strategy. This highlights the important role of regional and policy factors in amplifying the impact of digitalization. The study highlights that digital transformation not only improves operational efficiency, but also caters to consumers and their preference for innovative and sustainable practices, further cementing brand loyalty. By exploring the specific role of the digital economy for the business of sport, this study provides important insights into the use of digital tools to build green and loyal brands, offers practical insights for companies seeking to combine sustainability with digital strategies, and emphasizes the need to adapt approaches regionally. Embodying the transformative potential of the digital economy to address climate challenges, support low-carbon development and strengthen brand loyalty in the sports sector, this research contributes to the understanding of how businesses can thrive in an era of rapid environmental change.
    MeSH terms: Carbon; China; Commerce; Humans; Sports*; Climate Change*
  3. Buse K, Gostin L, Kamarulzaman A, McKee M
    BMJ, 2025 Jan 20;388:r116.
    PMID: 39837635 DOI: 10.1136/bmj.r116
  4. Tanimura S, Chuah SL, Shimizu S, Sakamoto S, Kasahara M, Nakagawa S
    Pediatr Transplant, 2025 Feb;29(1):e70032.
    PMID: 39837776 DOI: 10.1111/petr.70032
    BACKGROUND: Liver transplantation has improved survival rates in pediatric patients with end-stage liver failure. However, post-liver transplant infection remains a threat to patient recovery. This study reported the frequency and patterns of infections after liver transplantation and identified factors related to the accuracy of fever source investigation.

    METHOD: This is a single-center descriptive and retrospective study in the quaternary Pediatric Intensive Care Unit (PICU) in Japan. All pediatric patients who underwent liver transplantation from 2019 to 2021 were eligible. The patients were divided into two groups based on culture positivity: the positive culture group and the negative culture group.

    RESULTS: A total of 152 pediatric patients were included in the study. The median age was 11 months, and 86% of cases underwent living donor liver transplantation. Among the 152 cases, 18% showed positive bacterial culture results. The timing of positive culture varied bimodally, with 34% occurring after postoperative day 15. Among the positive cultures, 84% were bacterial, and 20% were fungal. Factors associated with positive culture were analyzed, and as a result, re-laparotomy and a higher graft recipient weight ratio (GRWR) were identified as factors associated with infection.

    CONCLUSIONS: We reported the frequency and patterns of infections in pediatric patients undergoing living donor liver transplantation and demonstrated that factors associated with positive culture were re-laparotomy and GRWR. This study provides important clinical data for infection management after liver transplantation.

    MeSH terms: Adolescent; Bacterial Infections/diagnosis; Bacterial Infections/etiology; Bacterial Infections/epidemiology; Child; Child, Preschool; Female; Humans; Infant; Japan/epidemiology; Male; Retrospective Studies; Risk Factors; Living Donors; End Stage Liver Disease/surgery
  5. Veesam SB, Satish AR, Tupakula S, Chinnam Y, Prakash K, Bansal S, et al.
    Sci Rep, 2025 Jan 21;15(1):2692.
    PMID: 39837915 DOI: 10.1038/s41598-025-85822-5
    It is important in the rising demands to have efficient anomaly detection in camera surveillance systems for improving public safety in a complex environment. Most of the available methods usually fail to capture the long-term temporal dependencies and spatial correlations, especially in dynamic multi-camera settings. Also, many traditional methods rely heavily on large labeled datasets, generalizing poorly when encountering unseen anomalies in the process. We introduce a new framework to address such challenges by incorporating state-of-the-art deep learning models that improve temporal and spatial context modeling. We combine RNNs with GATs to model long-term dependencies across cameras effectively distributed over space. The Transformer-Augmented RNN allows for a better way than standard RNNs through self-attention mechanisms to improve robust temporal modeling. We employ a Multimodal Variational Autoencoder-MVAE that fuses video, audio, and motion sensor information in a manner resistant to noise and missing samples. To address the challenge of having a few labeled anomalies, we apply the Prototypical Networks to perform few-shot learning and enable generalization based on a few examples. Then, a Spatiotemporal Autoencoder is adopted to realize unsupervised anomaly detection by learning normal behavior patterns and deviations from them as anomalies. The methods proposed here yield significant improvements of about 10% to 15% in precision, recall, and F1-scores over traditional models. Further, the generalization capability of the framework to unseen anomalies, up to a gain of + 20% on novel event detection, represents a major advancement for real-world surveillance systems.
  6. Wang T, Zhao Y, Zhang X, Xie Y, Pang LLL
    Sci Rep, 2025 Jan 21;15(1):2663.
    PMID: 39837980 DOI: 10.1038/s41598-025-85540-y
    As global populations age, ensuring the mobility safety of elderly individuals has become a prominent concern, highlighting the need for innovative designs in assistive products for seniors. This study aims to offer a scientific and practical design methodology for mobility aid designers, validated through the design of a walker for elderly users. To begin, potential user needs for walkers were identified using User Journey Mapping, with these needs categorized through the Kano model to establish a structured hierarchy of design requirements. Then, the Analytic Hierarchy Process was applied to weight these requirements, pinpointing the most critical design needs for walkers to guide practical design decisions. Finally, the Fuzzy Comprehensive Evaluation method was used to systematically assess walker design proposals, helping to identify the optimal solution and specifying areas for improvement. The findings demonstrate that the combined KANO-AHP-FCE framework effectively guides the design of walker products, enhancing their ability to meet user needs. This approach not only provides a valuable reference for future assistive product innovation but also contributes to solutions for enhancing elderly mobility safety in an aging society.
    MeSH terms: Aged; Aged, 80 and over; Equipment Design; Female; Humans; Male; Self-Help Devices*; Walkers*; Walking*
  7. Yip AJW, Lee YZ, Kow ASF, Wong CS, Lee MT, Tham CL, et al.
    Immunol Res, 2025 Jan 21;73(1):41.
    PMID: 39838115 DOI: 10.1007/s12026-024-09562-w
    Today, in the modern world, allergic diseases, also described as atopic allergies, are classified as a type of multifactorial disorder due to the complex interplay between genetics, environment, and socioeconomic factors that influence the disease's manifestation, severity, and one's predisposition to allergic diseases. It is undeniable that many reported studies have pointed out that the mast cell is one of the leading key players involved in triggering an allergic reaction. To improve our understanding of the molecular and cellular mechanisms underlying allergy, various mast cell lines have been employed in vitro to study the pathogenesis of allergic diseases for the past decades. However, there is no consensus on many fundamental aspects associated with their use, such as the effects of culture media composition and the type of inducer used for cell degranulation. As the standardization of research protocols and disease models is crucial, we present the outcome of a systematic review of scientific articles using three major immortalized in vitro mast cell lines (HMC-1, LAD2, and RBL-2H3) to study allergy. This systematic review described the cell source, culture conditions, inducers used for degranulation, and mediators released for examination. We hope that the present systematic review may help to standardize the use of immortalized in vitro mast cell lines in allergy research and serve as a user's guide to understand the fundamental aspects of allergy as well to develop an effective allergy therapy in the future for the betterment of human good health and wellbeing.
    MeSH terms: Animals; Cell Line; Humans; Cell Culture Techniques
  8. Htet H, Anaghan JRJ, Jaiprakash H, Burud IAS, Subramaniam T, Iezhitsa I, et al.
    BMC Cancer, 2025 Jan 21;25(1):110.
    PMID: 39838362 DOI: 10.1186/s12885-025-13528-y
    BACKGROUND: Nasopharyngeal carcinoma (NPC) is one of the most common head and neck cancers worldwide. The majority of the new cases were from Asia and are the leading cause of cancer in China. The main treatment is surgery and radiotherapy with chemotherapy for advanced cases. With the advancement of targeted therapies, the objective of this study was to investigate the efficacy and safety of targeted therapies in NPC.

    METHODS: Databases were searched from inception to Aug 2023, comparing molecular targeted therapies (MTT) with conventional chemotherapy, chemotherapy or surgery. Study screening, data extraction, and data analysis were conducted independently by two investigators. The Cochrane Risk of Bias tool 1.0 was used for the quality of the studies.

    RESULTS: There was a total of ten eligible studies with 471 participants in the treatment arm and 469 participants in the control arm. Most studies had an unclear risk of bias assessment. Upon network meta-analysis, cetuximab was found to be the most effective regimen for complete response (CR), bevacizumab was found to be the most effective regimen for partial response (PR), nimotuzumab was found to be the most effective regimen for overall survival rate (OS) and progression-free survival (PFS). Pairwise meta-analysis showed that MTT had a significantly better response than conventional therapies in complete response. GRADE analysis reported low certainty of evidence for CR and very low certainty of evidence for other efficacy outcomes. There was a higher chance of bleeding with MTT and was statistically significant.

    CONCLUSION: It was observed that targeted therapies were found to be a promising strategy for NPC especially recurrent and/or metastatic NPC, but the most appropriate therapy still needs to be evaluated.

    TRIAL REGISTRATION: This study was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) with a registration number of INPLASY202380024.

    MeSH terms: Bevacizumab/therapeutic use; Cetuximab/adverse effects; Cetuximab/therapeutic use; Humans; Treatment Outcome; Antibodies, Monoclonal, Humanized/therapeutic use; Network Meta-Analysis*
  9. Kumbargere SN, Quinn C, Callaghan L, Paisi M, Nasser M
    Health Res Policy Syst, 2025 Jan 21;23(1):12.
    PMID: 39838399 DOI: 10.1186/s12961-024-01261-0
    BACKGROUND: In the context of research priority-setting, participants express their research priorities and ideas in various forms, ranging from narratives to explicit topics or questions. However, the transition from these expressions to well-structured research topics or questions is not always straightforward. Challenges intensify when research priorities pertain to interventions or diagnostic accuracy, requiring the conversion of narratives into the Participant, Intervention, Comparator, Outcome (PICO) format.

    SCOPE AND FINDINGS: This project aimed to understand the challenges of engaging a diverse, multilingual population in setting oral health research priorities. While not a comprehensive priority-setting effort, we modified James Lind Alliance's (JLA) methods and used thematic analysis to establish a list of priority research topics and questions. This was accomplished by conducting interviews with 40 community participants and 14 dentists from various ethnic backgrounds in Malaysia. The interview language depended on participant preferences, including English, Malay, and Mandarin, with translations handled collaboratively by bilingual research assistants. The process involved thematic analysis, discussion with a research committee, and necessary modifications. Our interpretations revealed distinct categories of participant statements: explicit, complicated, implicit and incomplete. In this study, we identified a three-step approach to translate research ideas that are presented either as explicit statements or as complicated narratives.

    CONCLUSIONS: Translating community research priorities poses inherent challenges. Our model, although not exhaustive, provides a valuable tool to assist research priority-setting groups in translating these priorities into meaningful research topics and questions, facilitating the equitable inclusion of diverse perspectives. Future research priority-setting endeavours should document their translation processes, thus aiding researchers in understanding and tackling the intricacies of this task.

    MeSH terms: Health Equity; Adult; Ethnic Groups; Female; Health Priorities*; Humans; Interviews as Topic; Language; Malaysia; Male; Middle Aged; Oral Health*; Research; Multilingualism; Narration; Qualitative Research; Community-Based Participatory Research; Translational Medical Research
  10. Lim JJ, Reginald K, Say YH, Liu MH, Chew FT
    Clin Exp Allergy, 2025 Jan 21.
    PMID: 39838549 DOI: 10.1111/cea.14629
    This cross-sequential study found that frequent intake of high-fat and high-protein foods was associated with higher odds of atopic dermatitis (AD). However, occasional intake across all three macronutrients significantly lowered AD odds, suggesting that moderation-not strict avoidance-may benefit AD management in allergic populations.
  11. Sankar J, Rajendran K, Wong LS, Muthusamy K
    Curr Hypertens Rev, 2025 Jan 20.
    PMID: 39838689 DOI: 10.2174/0115734021342501250107052350
    INTRODUCTION: Hypertension is a chronic medical state and a major determining factor for cardiovascular and renal diseases. Both genetic and non-genetic factors contribute to hypertensive conditions among individuals. The renin-angiotensin-aldosterone system (RAAS) is a major genetic target for the anti-hypertension approach.

    PURPOSE OF THE STUDY: The majority of classical antihypertensive drugs were mainly focused on the RAAS signaling pathways. Though these antihypertensive drugs control blood pressure (BP), they have mild to severe life-threatening effects. Unrevealing effective hypertensive targets for BP management is essential. The effective targets could emerge either from RAAS-dependent or RAAS-independent pathways and/or through the cross-talks among them.

    RESULTS: Analyzing the physiopathological mechanisms of hypertension has the benefit of understanding the interactions between these systems which helps in better understanding of drug targets and the importance of emergence of novel therapeutics.

    CONCLUSION: This review is about the signaling pathways involved in hypertension pathogenesis and their cross-talks and it contributes to a better understanding of the etiology of hypertension.

  12. Tan JK, Ramsingh J
    J Surg Case Rep, 2025 Jan;2025(1):rjae842.
    PMID: 39839207 DOI: 10.1093/jscr/rjae842
    Paragangliomas, a type of extra-adrenal tumour, albeit rare, are dangerous due to their high metastatic potential and risk of hypertensive crisis from massive catecholamine release. It typically presents with sympathetic overdrive symptoms such as diaphoresis, headache, and palpitation, accompanied by substantially high plasma metanephrines level and mass on contrasted computed tomography abdomen and pelvis, whilst some are found incidentally. In this report, we discuss a case of an extra-adrenal lesion located near susceptible major structures with extensive vascularisation, in a patient with near-death experience. Complete excision of the pulsatile mass with minimal bleeding and no complications, was made possible utilizing the da Vinci Robotic System. Robotic surgery, being a part of a multidisciplinary approach, leads to better patient outcomes and shorter hospitalisations. Moreover, it offers enhanced dexterity and improved depth perception compared to conventional methods. However, further studies are needed to validate its application in standard practice.
  13. Mohammad SIS, Vasudevan A, Prasad KDV, Ali IR, Kumar A, Kulshreshta A, et al.
    Heliyon, 2025 Jan 15;11(1):e41416.
    PMID: 39839518 DOI: 10.1016/j.heliyon.2024.e41416
    PURPOSE: Biodiesel is a non-toxic, renewable, and environmentally friendly fuel used in compression ignition engines. This work aimed to develop Fe3O4/SiO2 as a cheap, magnetic, and easy separable catalyst for biodiesel production from waste oil by sono-catalytic transesterification.

    METHODS: Fe₃O₄-SiO₂ was prepared using a modified Stober method and used as a heterogeneous catalyst in an ultrasound-assisted transesterification reaction to produce biodiesel. The tests were designed by the Response surface methodology by considering the molar ratio of methanol to oil (M/O), catalyst weight percentage, and sonication time as independent factors. The produced biodiesel in diesel generator engines and the emission of pollutants were evaluated.

    RESULTS: The optimal production conditions were determined using the response surface methodology, which included a molar ratio of 8.30, a catalyst weight percentage of 5.30, and a sonication time of 30.02 min. The Pareto analysis indicated that the sonication time is the most important factor in the sono-catalytic transesterification of waste oil. The evaluation of the produced fuel showed that with an increase in the percentage of biodiesel in the engine's fuel input, CO emissions decreased by 0.027 % and smoke levels by 24 %, while NOx levels increased by 495 ppm. Additionally, the increase in biodiesel percentage led to a rise in brake-specific power by 44.6 kW and brake-specific fuel consumption by 89 g/kWh though brake torque decreased by 87 Nm.

    CONCLUSION: The study introduces significant advancements in biodiesel production technology through combining heterogeneous catalysis and ultrasound processing, optimizing production parameters for efficiency and sustainability while demonstrating improved environmental performance in diesel engines.

  14. Ponraj A, Nagaraj P, Balakrishnan D, Srinivasu PN, Shafi J, Kim W, et al.
    Digit Health, 2025;11:20552076241313161.
    PMID: 39839961 DOI: 10.1177/20552076241313161
    PURPOSE: Breast cancer encompasses various subtypes with distinct prognoses, necessitating accurate stratification methods. Current techniques rely on quantifying gene expression in limited subsets. Given the complexity of breast tissues, effective detection and classification of breast cancer is crucial in medical imaging. This study introduces a novel method, MPa-DCAE, which uses a multi-patch-based deep convolutional auto-encoder (DCAE) framework combined with VGG19 to detect and classify breast cancer in histopathology images.

    METHODS: The proposed MPa-DCAE model leverages the hierarchical feature extraction capabilities of VGG19 within a DCAE framework, designed to capture intricate patterns in histopathology images. By using a multi-patch approach, regions of interest are extracted from pathology images to facilitate localized feature learning, enhancing the model's discriminatory power. The auto-encoder component enables unsupervised feature learning, increasing resilience and adaptability to variations in image features. Experiments were conducted at various magnifications on the CBIS-DDSM and MIAS datasets to validate model performance.

    RESULTS: Experimental results demonstrated that the MPa-DCAE model outperformed existing methods. For the CBIS-DDSM dataset, the model achieved a precision of 97.96%, a recall of 94.85%, and an accuracy of 98.36%. For the MIAS dataset, it achieved a precision of 97.99%, a recall of 97.2%, and an accuracy of 98.95%. These results highlight the model's robustness and potential for clinical application in computer-assisted diagnosis.

    CONCLUSION: The MPa-DCAE model, integrating VGG19 and DCAE, proves to be an effective, automated approach for diagnosing breast cancer. Its high accuracy and generalizability make it a promising tool for clinical practice, potentially improving patient care in histopathology-based breast cancer diagnosis.

  15. Ghaben SJ, Mat Ludin AF, Mohamad Ali N, Singh DKA
    Digit Health, 2025;11:20552076241307476.
    PMID: 39839963 DOI: 10.1177/20552076241307476
    BACKGROUND: The increasing prevalence and burden of chronic obstructive pulmonary disorder (COPD), the challenges in implementing pulmonary rehabilitation (PR) programs and the limited availability of alternatives and supportive programs to serve patients with COPD necessitate the development of pulmonary telerehabilitation (PTR) systems to provide patients with COPD with PR programs.

    OBJECTIVE: This study aimed to design and develop the ChestCare mobile Health app using user-centred design (UCD) approach. Thus, it provided PTR for patients with COPD, enhancing their self-management of symptoms and improving their compliance with PR programs.

    METHODS: In this mixed-methods sequential research, we deployed the UCD iterative design through the prototype app design and development sequence. The first phase was built based on the results of a previous needs assessment study and an analysis of related apps. This produced the initial mock-up, the foundation for the focus group discussions with physiotherapists and patients. Six physiotherapists with cardiorespiratory specialisation evaluated each app module and item of the latest mock-up using the content validity index (CVI) document. The I-CVI (S-CVI/Ave) and (S-CVI/UA) were computed. Qualitative and quantitative data were integrated, and decisions were made by comparing their results.

    RESULTS: The UCD iterative design through sequential MMR has generated four mock-up app versions. The latest version identified 13 modules through 150 items validated by six experts using a CVI document. The I-CVI calculation of 145 items was 1, while 0.83 for the remaining items, was within accepted values. The S-CVI scored 99.4, indicating an overall validity of the ChestCare app as a PTR system for patients with COPD.

    CONCLUSIONS: The development and validation of the ChestCare app resulted from conducting UCD iterative design and sequential MMR, which identified 13 functionalities, including symptom assessment, tracking lung volume, functional capacity test, action plan, intervention program, COPD education, COPD community, monitoring and reminders.

  16. Bakhsh A, Kim B, Ishamri I, Choi S, Li X, Li Q, et al.
    Food Sci Anim Resour, 2025 Jan;45(1):145-164.
    PMID: 39840246 DOI: 10.5851/kosfa.2024.e122
    Cell-based meat (CBM) technology is a highly promising alternative to traditional animal agriculture, with considerable advantages in terms of sustainability, animal welfare, and food security. Nonetheless, CBM's successful commercialization is dependent on efficiently dealing with several critical concerns, including ensuring biological, chemical, and nutritional safety as well as navigating the global regulatory framework. To ensure CBM's biological safety, detecting and mitigating any potential hazards introduced during the manufacturing process is crucial. Concerns include microbial contamination, the utilization of animal-derived growth media, and the risk of viral or prion infection. Similarly, chemical hazards include residues from growth media, scaffolding materials, and other bioprocessing agents. For consumer acceptance, CBM's nutritional qualities should be comparable to those of conventional meat, indicating adequate protein content, essential amino acids, vitamins, and minerals. Additionally, CBM's safety in terms of allergenicity and the presence of anti-nutritional factors must be rigorously assessed. Advances in cell culture techniques and biomanufacturing methods are requisite to achieving high-quality CBM with desirable nutritional attributes. The regulatory framework for CBM is actively expanding, with significant regional variations. Singapore is currently the only country that has received approval for the market placement of CBM, although the United States has developed a regulatory structure involving the United States Department of Agriculture and Food and Drug Administration. As CBM holds great potential as a sustainable and ethical alternative to conventional meat, addressing challenges related to biological and chemical safety, nutritional quality, and regulatory approval is essential for its successful market integration.
  17. Patel S, Teng PH, Liao WC, Davis MC, Fidler A, Haupt F, et al.
    Int Endod J, 2025 Mar;58(3):379-390.
    PMID: 39840523 DOI: 10.1111/iej.14186
    This position statement is a consensus view of an expert committee convened by the European Society of Endodontology (ESE). The statement is based on current clinical and scientific evidence as well as the collective reflective practice of the committee. The aim is to provide clinicians with evidence-based, authoritative information on the aetiology, clinical presentation, and management of cracks and fractures that typically manifest along the long axis of the crown and/or root.
    MeSH terms: Cracked Tooth Syndrome/diagnosis; Cracked Tooth Syndrome/etiology; Cracked Tooth Syndrome/therapy; Humans; Tooth Root/injuries
  18. Ang ZY, Kong YL, Md Nesran ZN, Lee SWH
    BJU Int, 2025 Feb;135(2):222-234.
    PMID: 39402746 DOI: 10.1111/bju.16545
    OBJECTIVE: To review and compare the efficacy of different delivery modes of decision aids (DAs), including computer-based, print-based, multimedia-based, video-based, and website-based on decision-making outcomes for prostate cancer screening compared to usual care (UC) and among the delivery modes.

    METHODS: PubMed, the Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Advanced Search, and Turning Research Into Practice (TRIP) Database were systematically searched from inception to August 2023. The primary outcomes were knowledge level, knowledge scores, participation in shared decision-making (SDM), decisional conflict, and preference for SDM participation. Secondary outcomes were the proportion of subjects who underwent screening (actual screening utilisation) and the proportion of subjects who intended to be screened (intention to undergo screening). Network and pairwise meta-analyses were performed using random-effects models.

    RESULTS: Seven systematic reviews were included. Network meta-analysis found that multimedia (relative risk [RR] 1.51, 95% confidence interval [CI] 1.02-2.24), print (RR 1.82, 95% CI 1.23-2.69), and website-based (RR 1.99, 95% CI 1.32-3.01) DAs significantly increased participation in SDM compared to the computer-based DA. There was a significant reduction in the actual screening utilisation in the computer DA arm compared to the other delivery modes. No significant differences between all delivery modes were noted on knowledge levels, knowledge scores, decisional conflict, preference for SDM participation, and intention to undergo screening. The highest mean surface under the cumulative ranking curve for all primary outcomes showed that website-based was the most effective delivery mode, followed by print-based DA. The pairwise meta-analysis showed a significant increase in participants' knowledge level, knowledge scores, a reduced intention to undergo screening and actual screening utilisation compared to UC.

    CONCLUSIONS: The findings suggest that different types of DAs have varying levels of effectiveness in increasing knowledge level, knowledge scores, participation in SDM, and influencing screening behaviours. While website-based DA appeared the most effective, employing the print-based DA could be a practical solution in settings with limited resources.

    MeSH terms: Decision Support Techniques*; Humans; Male; Network Meta-Analysis*
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