The development of laparoscopic skills using virtual reality simulations: A systematic review

Background Teaching based on virtual reality simulators in medicine has expanded in recent years due to the limitations of more traditional methods, especially for surgical procedures such as laparoscopy. Purpose of review To analyze the effects of using virtual reality simulations on the development of laparoscopic skills in medical students and physicians. Data sources The literature screening was done in April 2020 through Medline (PubMed), EMBASE and Database of the National Institute of Health. Eligibility criteria Randomized clinical trials that subjected medical students and physicians to training in laparoscopic skills in virtual reality simulators. Study appraisal Paired reviewers independently identified 1529 articles and included 7 trials that met the eligibility criteria. Findings In all studies, participants that trained in virtual simulators showed improvements in laparoscopic skills, although the articles that also had a physical model training group did not show better performance of one model compared to the other. Limitations No article beyond 2015 met the eligibility criteria, and the analyzed simulators have different versions and models, which might impact the results. Conclusion Virtual reality simulators are useful educational tools, but do not show proven significant advantages over traditional models. The lack of standardization and a scarcity of articles makes comparative analysis between simulators difficult, requiring more research in the area, according to the model suggested in this review. Systematic review registration number Registered by the Prospective Register of Systematic Reviews (PROSPERO), identification code CRD42020176479.

Download Full-text

Pharmacologic interventions for postoperative nausea and vomiting after thyroidectomy: A systematic review and network meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0243865 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0243865

Author(s):

Ye Jin Cho ◽

Geun Joo Choi ◽

Eun Jin Ahn ◽

Hyun Kang

Keyword(s):

Systematic Review ◽

Postoperative Nausea ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Complete Response ◽

Nausea And Vomiting ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Registration Number

Objective To determine the effectiveness of pharmacologic interventions for preventing postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. Design Systematic review and network meta-analysis (NMA). Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar. Eligibility criteria, participants, and interventions Randomized clinical trials that investigated the efficacy of pharmacologic interventions in preventing PONV in patients undergoing thyroidectomy were included. The primary endpoints were the incidences of postoperative nausea and vomiting (PONV), postoperative nausea (PON), postoperative vomiting (POV), use of rescue antiemetics, and incidence of complete response in the overall postoperative phases. The secondary endpoints were the same parameters assessed in the early, middle, and late postoperative phases. The surface under the cumulative ranking curve (SUCRA) values and rankograms were used to present the hierarchy of pharmacologic interventions. Results Twenty-six studies (n = 3,467 patients) that investigated 17 different pharmacologic interventions were included. According to the SUCRA values, the incidence of PONV among the overall postoperative phases was lowest with propofol alone (16.1%), followed by palonosetron (27.5%), and with tropisetron (28.7%). The incidence of PON among the overall postoperative phases was lowest with propofol alone (11.8%), followed by tropisetron and propofol combination (14%), and ramosetron and dexamethasone combination (18.0%). The incidence of POV among the overall postoperative phases was lowest with tropisetron and propofol combination (2.2%), followed by ramosetron and dexamethasone combination (23.2%), and tropisetron alone (37.3%). The least usage of rescue antiemetics among the overall postoperative phases and the highest complete response was observed with tropisetron and propofol combination (3.9% and 96.6%, respectively). Conclusion Propofol and tropisetron alone and in combination, and the ramosetron and dexamethasone combination effectively prevented PONV, PON, POV in patients undergoing thyroidectomy, with some heterogeneity observed in this NMA of full-text reports. Their use minimized the need for rescue antiemetics and enhanced the complete response. Trial registration number CRD42018100002.

Download Full-text

Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review

International Journal for Equity in Health ◽

10.1186/s12939-020-01375-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sara Lena Lueckmann ◽

Jens Hoebel ◽

Julia Roick ◽

Jenny Markert ◽

Jacob Spallek ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Primary Care Physicians ◽

Web Of Science ◽

Adult Population ◽

Socioeconomic Inequalities ◽

Eligibility Criteria ◽

Physician Visits ◽

General Adult Population ◽

Registration Number

Abstract Background Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries. Methods We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria. Results Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES. Conclusion This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare. PROSPERO registration number CRD42019123222.

Download Full-text

Efficacy and safety of instantaneous wave-free ratio in patients undergoing coronary revascularisation: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-017868 ◽

2017 ◽

Vol 7 (9) ◽

pp. e017868

Author(s):

Joey S.W. Kwong ◽

Sheyu Li ◽

Wan-Jie Gu ◽

Hao Chen ◽

Chao Zhang ◽

...

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Meta Analysis ◽

Adverse Outcomes ◽

Coronary Revascularisation ◽

Eligibility Criteria ◽

Registration Number ◽

Collection Form ◽

Randomised Controlled ◽

Meta Analyses

IntroductionEffective selection of coronary lesions for revascularisation is pivotal in the management of symptoms and adverse outcomes in patients with coronary artery disease. Recently, instantaneous ‘wave-free’ ratio (iFR) has been proposed as a new diagnostic index for assessing the severity of coronary stenoses without the need of pharmacological vasodilation. Evidence of the effectiveness of iFR-guided revascularisation is emerging and a systematic review is warranted.Methods and analysisThis is a protocol for a systematic review of randomised controlled trials and controlled observational studies. Electronic sources including MEDLINE via Ovid, Embase, Cochrane databases and ClinicalTrials.gov will be searched for potentially eligible studies investigating the effects of iFR-guided strategy in patients undergoing coronary revascularisation. Studies will be selected against transparent eligibility criteria and data will be extracted using a prestandardised data collection form by two independent authors. Risk of bias in included studies and overall quality of evidence will be assessed using validated methodological tools. Meta-analysis will be performed using the Review Manager software. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.Ethics and disseminationEthics approval is not required. Results of the systematic review will be disseminated as conference proceedings and peer-reviewed journal publication.Trial registration numberThis protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017065460.

Download Full-text

Efficacy, immunogenicity and safety of a recombinant tetravalent dengue vaccine (CYD-TDV) in children aged 2–17 years: systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-019368 ◽

2019 ◽

Vol 9 (3) ◽

pp. e019368 ◽

Cited By ~ 3

Author(s):

Bruno Rodrigues Rosa ◽

Antonio José Ledo Alves da Cunha ◽

Roberto de Andrade Medronho

Keyword(s):

Systematic Review ◽

Incomplete Data ◽

Meta Analysis ◽

Randomised Trials ◽

Dengue Vaccine ◽

Eligibility Criteria ◽

Registration Number ◽

Randomised Controlled

BackgroundRandomised controlled trials have evaluated the recombinant tetravalent dengue vaccine (CYD-TDV). However, individual results may have little power to identify differences among the populations studied.ObjectiveTo evaluate efficacy, immunogenicity and safety of CYD-TDV in the prevention of dengue in children aged 2–17 years.DesignSystematic review and meta-analysis.Data sourcesMEDLINE (from 1950 to 5 December 2018), EMBASE (from 1947 to 5 December 2018) and Cochrane (from 1993 to 5 December 2018).Eligibility criteria of studiesRandomised trials comparing efficacy, immunogenicity and safety of CYD-TDV with placebo or other vaccines for preventing dengue cases in children aged 2–17 years.Outcome measuresEfficacy, immunogenicity and safety of CYD-TDV.Study appraisal and methodsCalculations were made of relative risk (RR) and mean difference (MD) for dichotomous and continuous outcomes, respectively. All estimates were calculated considering a 95% CI estimate. A p<0.05 was considered statistically significant.ResultsNine studies involving 34 248 participants were included. The overall efficacy of CYD-TDV was 60% (RR 0.40 (0.30 to 0.54)). Serotype-specific efficacy of the vaccine was 51% for dengue virus type-1 (DENV-1) (RR 0.49 (0.39 to 0.63)); 34% for DENV-2 (RR 0.66 (0.50 to 0.86)); 75% for DENV-3 (RR 0.25 (0.18 to 0.35)) and 77% for DENV-4 (RR 0.23 (0.15 to 0.34)). Overall immunogenicity (MD) of CYD-TDV was 225.13 (190.34 to 259.93). Serotype-specific immunogenicity was: DENV-1: 176.59 (123.36 to 229.83); DENV-2: 294.21 (181.98 to 406.45); DENV-3: 258.78 (146.72 to 370.84) and DENV-4: 189.35 (141.11 to 237.59). The most common adverse events were headache and pain at the injection site.LimitationsThe main limitation of this study was unclear or incomplete data.Conclusions and implications of key findingsCYD-TDV is considered safe and able to partially protect children and adolescents against four serotypes of DENV for a 1-year period. Despite this, research should prioritise improvements in vaccine efficacy, thus proving higher long-term protection against all virus serotypes.PROSPERO registration numberCRD42016043628.

Download Full-text

Is a low Functional Movement Screen score (≤14/21) associated with injuries in sport? A systematic review and meta-analysis

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2018-000501 ◽

2019 ◽

Vol 5 (1) ◽

pp. e000501 ◽

Cited By ~ 1

Author(s):

Manuel Trinidad-Fernandez ◽

Manuel Gonzalez-Sanchez ◽

Antonio I Cuesta-Vargas

Keyword(s):

Systematic Review ◽

Female Athletes ◽

Meta Analysis ◽

Functional Movement Screen ◽

Eligibility Criteria ◽

Functional Movement ◽

Increased Risk ◽

Registration Number ◽

Definition Of ◽

Evidence Database

ObjectiveTo assess whether Functional Movement Screen (FMS) score is associated with subsequent injuries in healthy sportspeople.DesignSystematic review and meta-analysis.Data sourcesThe following electronic databases were searched to December 2017: Medline, PubMed, PsycINFO, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature, Scopus, Embase, and Physiotherapy Evidence Database.Eligibility criteria for selecting studiesEligibility criteria included (1) prospective cohort studies that examined the association between FMS score (≤14/21) and subsequent injuries, (2) a sample of healthy and active participants without restrictions in gender or age, and (3) the OR was the effect size and the main outcome.ResultsThirteen studies met the criteria for the systematic review and 12 were included in the meta-analysis. In 5 of the 12 studies, and among female athletes in 1 study, FMS score ≤14 out of 21 points was associated with subsequent injuries. The overall OR of the selected studies in the meta-analysis was 1.86 (95% CI 1.32 to 2.61) and showed substantial heterogeneity (I2=70%).Summary/ConclusionWhether or not a low FMS score ≤14 out of 21 points is associated with increased risk of injury is unclear. The heterogeneity of the study populations (type of athletes, age and sport exposure) and the definition of injury used in the studies make it difficult to synthesise the evidence and draw definitive conclusions.Trial registration numberCRD42015015579.

Download Full-text

Hallux valgus orthosis characteristics and effectiveness: a systematic review with meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-047273 ◽

2021 ◽

Vol 11 (8) ◽

pp. e047273

Author(s):

Mei-Ying Kwan ◽

Kit-Lun Yick ◽

Joanne Yip ◽

Chi-Yung Tse

Keyword(s):

Systematic Review ◽

Hallux Valgus ◽

Outcome Measurement ◽

Meta Analysis ◽

Outcome Data ◽

Risk Of Bias ◽

Eligibility Criteria ◽

Systematic Analysis ◽

Registration Number ◽

Mean Differences

ObjectiveThe treatment effect of orthoses for hallux valgus (HV) is unclear with little interventional studies, the design involves multiple complex factors, and therefore a systematic analysis with meta-analysis is necessary. The objective of this systematic review and meta-analysis is to determine whether current foot orthoses are effective in treating HV.DesignSystematic review with meta-analysis.Data sourcesElectronic databases (PubMed, Scopus, Cinahl and Medline) are searched up to February 2020.Eligibility criteria for selecting studiesInterventional studies with content focus on HV orthosis design and any of the outcomes related to effectiveness for treating HV are included. The standardised mean differences are calculated. The risk of bias in included studies is assessed using the Cochrane Collaboration’s risk of bias tools.ResultsIn total, 2066 articles are identified. Among them, nine are selected and quality rated, and data are extracted and closely examined. A meta-analysis is conducted, where appropriate. The main causes of potential bias are missing outcome data and outcome measurement error. The results show that orthosis with a toe separator has the best effect of correcting the HV angle (standardised mean difference: 0.50, 95% CI: 0.189 to 0.803).ConclusionThe orthoses design with a toe separator or an element that allows for the foot anatomic alignment is critical for reducing the HV angle and relieving foot pain. The results contribute to a better selection of treatment for patients.PROSPERO registration numberCRD42021260403.

Download Full-text

Landscapes of becoming social: A systematic review of evidence for associations and pathways between interactions with nature and socioemotional development in children

10.31219/osf.io/dc4rz ◽

2020 ◽

Author(s):

Lærke Mygind ◽

Mette Kurtzhals ◽

Clare Nowell ◽

Paulina S. Melby ◽

Matt P. Stevenson ◽

...

Keyword(s):

Systematic Review ◽

Green Space ◽

Internal Validity ◽

Later Life ◽

Risk Of Bias ◽

Observational Research ◽

Synthesis Methods ◽

Eligibility Criteria ◽

Registration Number ◽

Socioemotional Outcomes

Background. Existing research indicates that spending time in nature is associated with diverse aspects of children’s health and wellbeing. Although fundamental to later life chances and health, no systematic reviews, to our knowledge, have focused specifically on the effects of interaction with nature on socioemotional functioning in childhood. Objectives. Amongst children, what is the consistency of associations between the availability of or spending time in nature on socioemotional function and development? Furthermore, which child behaviours and states independently associate with socioemotional function and availability of or spending time in nature, and what is the consistency of associations between these behaviours and states and contact with nature?Data sources. Embase, Environment Complete, MEDLINE, and APA PsycINFO. Eligible studies were backward and forward snowball-searched. Study eligibility criteria. Studies investigating effects of, or associations between, availability of or interaction with nature on socioemotional or proximal outcomes in children under the age of 12 years were included in this review. Study appraisal and synthesis methods. The internal validity of studies investigating socioemotional outcomes were based on assessments of elements of study design, conduct, and reporting to identify potential issues related to confounding or other biases. The number of analyses indicating positive, negative, and non-significant associations between availability or interaction with green space and the outcomes were summed.Results. A total of 223 eligible full-texts, of which 43 pertained to socioemotional outcomes and 180 to proximal outcomes, met eligibility criteria. Positive associations between availability of and spending time in green space were found with children’s intra- and interpersonal socioemotional function and development. Proportions of positive findings ranged from 13.9% to 55% across experimental and observational research, exposures, populations, and contexts. Modifying and mediating factors were identified. We found consistent evidence for improved aspects of cognition and, for children over six years, reduced risk of obesity and overweight in association with green space; consistent links between movement behaviours in the experimental, but not observational research; tentative trends suggesting associations with play, motor skills, language, screen time, and communication skills; little evidence for positive associations between green space and mood, physical wellbeing, and stress; some evidence for associations with healthy birth outcomes, and little evidence for direct associations between availability of green space and asthma and allergy prevalence, however, mediation via, for example, air pollution was likely.Limitations. We identified few studies without either probable or severe risk of bias in at least one item. Improved study quality may therefore result in different results. Restricting analyses to include only studies considered at low risk of bias indicated similar or slightly lower proportions of positive findings. Risk of bias in proximal outcomes was not assessed.Conclusions. The empirical evidence for benefits of availability of and interaction green space for child socioemotional function and development must currently be considered limited. A number of proximal indicators were identified. Systematic review registration number. PROSPERO ID: CRD42019135016.

Download Full-text

The therapeutic use of essential oils in the care of cancer patients in chemotherapy: A systematic review

Brazilian Journal of Health and Biomedical Sciences ◽

10.12957/bjhbs.2021.59744 ◽

2021 ◽

Vol 20 (1) ◽

pp. 36-45

Author(s):

Bruno B. Monteiro-Oliveira ◽

Ana Carolina Coelho-Oliveira ◽

Tatiane S. A. David ◽

Adriana T. Brito ◽

Ana Carla A. Cruz ◽

...

Keyword(s):

Systematic Review ◽

Adverse Effects ◽

Essential Oils ◽

Methodological Quality ◽

Randomized Clinical Trials ◽

Database Search ◽

Quality Of Sleep ◽

Effective Technique ◽

Eligibility Criteria

Introducton: Chemotherapy is an important therapy in the treatment of cancer. Nausea, vomiting and worsening quality are some adverse effects of chemotherapy. Aromatherapy is an ancient technique that uses essential oils for physical and psychological/emotional improvement and is able to reduce the symptoms of chemotherapy and can be an excellent complementary technique.Objective: The aim of this systematic review was to determine the effects of aromatherapy on the adverse effects of chemotherapy in patients diagnosed with cancer. Methods: A search in three database PubMed, EMBASE and SCOPUS. Five studies that analyzed the use of aromatherapy to evaluate the reduction of the adverse effects of chemotherapy in a cancer patient, published only in English were included. Two reviewers, which independently examined titles and abstracts, identified records through database search and reference screening and irrelevant studies were excluded based in eligibility criteria. Relevant full texts were analyzed for eligibility, and all selected studies were included in this systematic review. Results: Five studies were included in this systematic review. This review suggests that aromatherapy reduces nausea, frequency of vomiting and improves quality of sleep. Conclusion: Aromatherapy is an effective technique to reduce nausea, the frequency of vomiting and improves the quality of sleep of patients diagnosed with cancer and undergoing chemotherapy. However, more randomized clinical trials with a good methodological quality are necessary to confirm the preliminary findings of this systematic review.

Download Full-text

Is mindfulness research methodology improving over time? A systematic review

10.31231/osf.io/nm7a8 ◽

2018 ◽

Author(s):

Simon Goldberg ◽

Raymond P. Tucker ◽

Preston A. Greene ◽

Tracy L. Simpson ◽

David Kearney ◽

...

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Scientific Evidence ◽

Treatment Fidelity ◽

The Body ◽

Synthesis Methods ◽

Eligibility Criteria ◽

Clinical Disorder ◽

Fidelity Assessment ◽

Methodological Improvement

Background: Despite an exponential growth in research on mindfulness-based interventions, the body of scientific evidence supporting these treatments has been criticized for being of poor methodological quality. Objectives: The current systematic review examined the extent to which mindfulness research demonstrated increased rigor over the past 16 years regarding six methodological features that have been highlighted as areas for improvement. These feature included using active control conditions, larger sample sizes, longer follow-up assessment, treatment fidelity assessment, and reporting of instructor training and intent-to-treat (ITT) analyses. Data sources: We searched PubMed, PsychInfo, Scopus, and Web of Science in addition to a publically available repository of mindfulness studies. Study eligibility criteria: Randomized clinical trials of mindfulness-based interventions for samples with a clinical disorder or elevated symptoms of a clinical disorder listed on the American Psychological Association’s list of disorders with recognized evidence-based treatment. Study appraisal and synthesis methods: Independent raters screened 9,067 titles and abstracts, with 303 full text reviews. Of these, 171 were included, representing 142 non-overlapping samples. Results: Across the 142 studies published between 2000 and 2016, there was no evidence for increases in any study quality indicator, although changes were generally in the direction of improved quality. When restricting the sample to those conducted in Europe and North America (continents with the longest history of scientific research in this area), an increase in reporting of ITT analyses was found. When excluding an early, high-quality study, improvements were seen in sample size, treatment fidelity assessment, and reporting of ITT analyses. Conclusions and implications of key findings: Taken together, the findings suggest modest adoption of the recommendations for methodological improvement voiced repeatedly in the literature. Possible explanations for this and implications for interpreting this body of research and conducting future studies are discussed.

Download Full-text

What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-026037 ◽

2019 ◽

Vol 9 (8) ◽

pp. e026037 ◽

Cited By ~ 2

Author(s):

Gillian Sandra Gould ◽

Laura Twyman ◽

Leah Stevenson ◽

Gabrielle R Gribbin ◽

Billie Bonevski ◽

...

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Data Extraction ◽

Meta Analysis ◽

Self Report ◽

Health Providers ◽

Eligibility Criteria ◽

Reporting Practices ◽

Registration Number ◽

Meta Analyses

BackgroundPregnancy is an opportunity for health providers to support women to stop smoking.ObjectivesIdentify the pooled prevalence for health providers in providing components of smoking cessation care to women who smoke during pregnancy.DesignA systematic review synthesising original articles that reported on (1) prevalence of health providers’ performing the 5As (‘Ask’, ‘Advise’, ‘Assess’, ‘Assist’, ‘Arrange’), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care.Data sourcesMEDLINE, EMBASE, CINAHL and PsycINFO databases searched using ‘smoking’, ‘pregnancy’ and ‘health provider practices’.Eligibility criteria for selecting studiesStudies included any design except interventions (self-report, audit, observed consultations and women’s reports), in English, with no date restriction, up to June 2017.ParticipantsHealth providers of any profession.Data extraction, appraisal and analysisData were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, ‘often/always’ and ‘always/all’. Meta-regressions were performed of 5As for ‘often/always’.ResultsOf 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices ‘often/always’ were: ‘Ask’ (n=9) 91.6% (95% CI 88.2% to 95%); ‘Advise’ (n=7) 90% (95% CI 72.5% to 99.3%), ‘Assess’ (n=3) 79.2% (95% CI 76.5% to 81.8%), ‘Assist (cessation support)’ (n=5) 59.1% (95% CI 56% to 62.2%), ‘Arrange (referral)’ (n=6) 33.3% (95% CI 20.4% to 46.2%) and ‘prescribing NRT’ (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I2) was 95.9%–99.1%. Meta-regressions for ‘Arrange’ were significant for year (p=0.013) and country (p=0.037).ConclusionsHealth providers ‘Ask’, ‘Advise’ and ‘Assess’ most pregnant women about smoking. ‘Assist’, ‘Arrange’ and ‘prescribing NRT’ are reported at lower rates: strategies to improve these should be considered.PROSPERO registration numberCRD42015029989.

Download Full-text