Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 6 appraisals
Antimicrobial resistance and infection control
Time-related changes in bacterial air contamination of sterile covered items in operating rooms: a systematic review and meta-analysis
BACKGROUND: There is still only limited evidence regarding how bacterial air contamination of sterile items changes over time in the operating room, even when protected by sterile covers. This review aimed to synthesize the available data to inform safe handling and preparation of sterile equipment. METHODS: A systematic search was conducted for controlled studies that assessed time-related bacterial contamination of covered sterile items in operating rooms and that reported the outcome as colony forming units (CFU) measured at two or more time points, generating distinct timelines. Six databases were searched from inception to 1 September 2025: Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, the Cochrane Database of Systematic Reviews, Embase, and Web of Science. A meta-analysis was performed using linear regression with CFU as the dependent variable and time (minutes) as the independent variable. The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251018280). RESULTS: Five timelines from four studies evaluating CFU counts yielded an R2 of 0.085, indicating that time explained 8.5% of CFU variation. Similarly, analysis of eight timelines from four studies assessing mean CFU values produced an R2 of 0.070, attributing 7% of variation to time. Neither analysis demonstrated a statistically significant linear association between time and CFU count (p = 0.176, CI: -1.319 < β < 4.863) or mean CFU values (p = 0.108, CI: 0.191 < β < 0.420) when sterile covers were used. Three additional timelines excluded from the meta-analysis showed mixed results: two indicated a positive association, while one showed no relationship. CONCLUSIONS: Time has only a modest impact on bacterial contamination of sterile items when protective covers are used, with minimal increases in CFU over different waiting periods. Clinically, this confirms that properly covered sterile items can be prepared in advance without compromising microbial safety, thus supporting efficient operating room organization and workflow. These findings reinforce the effectiveness of sterile covers as a key measure to reduce the risk of surgical site infections and ensure the safe handling of sterile equipment. Although covered storage appears safe, minimizing unnecessary waiting time, even with coverage, is good clinical practice.
15 May 2026
Read appraisal →Journal of clinical microbiology
Prediction of KPC-producing Klebsiella pneumoniae by MALDI-TOF MS, ensemble learning, and spectral peak annotation
The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae represents a serious global health challenge. Rapid and accurate detection methods are essential to inform early and correct use of antimicrobial therapy to idealize patient outcomes and limit the spread of resistant isolates. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been evaluated for resistance detection, but its clinical application remains limited. In this study, MALDI-TOF MS was integrated with machine learning (ML) to improve detection of Klebsiella pneumoniae carbapenemase (KPC) among K. pneumoniae isolates harboring KPC carbapenemase. Ensemble learning strategies were applied to 435 clinical isolates from different geographic locations (Spain, United States, South America, and Asia), with validation performed using external data sets. By constructing two peak matrices and applying four ML algorithms, as well as combinations of two and three in ensemble models, 92 different classifiers were tested. Ensemble combinations increased the specificity of classifiers to over 95%, while sensitivity reached 72%, being significantly higher than that of the MALDI Biotyper KPC module. Low sensitivity may be affected by technical variability during spectral acquisition. The first annotated MALDI-TOF MS spectrum for K. pneumoniae by in silico prediction of protein masses was developed to enable peak identification, including peaks potentially related to antimicrobial resistance. Overall, the results of this study show that combining MALDI-TOF MS with ensemble learning can enhance KPC detection performance.IMPORTANCERapid and accurate detection of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae informs early and correct use of antimicrobial therapy to idealize patient outcomes and limit the spread of antimicrobial resistance. In this study, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and ensemble machine learning were employed to detect KPC-producing isolates, using diverse isolate collections, obtaining excellent specificity. An annotated K. pneumoniae MALDI-TOF MS profile is provided with peak annotation, providing a resource for peak analysis.
14 May 2026
Read appraisal →JMIR mHealth and uHealth
Effectiveness of Mobile Health Interventions in Pediatric Cancer: Systematic Review and Meta-Analysis of Randomized Controlled Trials
BACKGROUND: Cancer poses a significant threat to children's health, and mobile health (mHealth) is emerging as a key tool for remote disease management, health education, and follow-up. However, evidence of its effectiveness remains limited. OBJECTIVE: This study aimed to summarize the effects of mHealth interventions for pediatric cancer compared with usual care, providing evidence-based support for optimizing intervention models and improving patient outcomes. METHODS: A systematic search of 14 databases identified randomized controlled trials (RCTs) on mHealth apps for pediatric patients with cancer from inception to August 1, 2025. Two reviewers independently screened studies, extracted data, assessed bias risk, and graded evidence quality. The meta-analysis was conducted using RevMan 5.4 and Stata 15. RESULTS: A total of 24 RCTs involving 2645 patients were included. This review found that mHealth interventions significantly reduced infection rates (odds ratio [OR] 0.25, 95% CI 0.10-0.60; P=.002) and the overall incidence of peripherally inserted central catheter (PICC) complications (OR 0.16, 95% CI 0.10-0.24; P<.001), while improving quality of life (standardized mean difference [SMD] 1.34, 95% CI 0.13-2.55; P=.03), self-management ability (SMD 6.39, 95% CI 1.26-11.53; P=.01), and treatment adherence (OR 2.83, 95% CI 1.41-5.66; P=.003). However, mHealth interventions had no significant effect on PICC catheter displacement (OR 0.44, 95% CI 0.15-1.29; P=.13) or health knowledge (SMD 4.44, 95% CI -2.40 to 11.29; P=.20). Further high-quality studies are needed to verify their impact in these areas. The intervention components covered 9 behavior change techniques: goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution, reward and threat, comparison of outcomes, natural consequences, and regulation. CONCLUSIONS: This systematic review and meta-analysis synthesized evidence from RCTs. The findings support the use of mHealth to reduce infections and PICC-related complications among pediatric patients with cancer while improving quality of life, self-management capabilities, and treatment adherence. These results underscore the importance of incorporating mHealth strategies into pediatric cancer care and guide the development and enhancement of future mHealth interventions.
26 Apr 2026
Read appraisal →Nanoscale
Bifunctional PVDF/MXene membranes with high piezoelectric sensitivity and near infrared photothermal antibacterial efficacy toward wearable human activity monitoring
In the realm of wearable health monitoring, establishing a reliable interface that ensures both high-fidelity sensing and long-term biological safety remains a critical challenge, particularly due to the risk of bacterial infection caused by sweat accumulation at the device-skin contact. Herein, we address this issue by developing a scenario-driven, bifunctional PVDF/MXene nanofibrous membrane that integrates robust piezoelectric performance with on-demand photothermal antibacterial capability. In this design, MXene nanosheets function simultaneously as nucleating agents to boost the electroactive β-phase content of PVDF from 80.3% to 93.3% and as efficient near-infrared (NIR) photothermal agents. The optimized membrane exhibits a superior piezoelectric sensitivity of 0.502 V/N, enabling the precise detection of diverse human activities ranging from subtle pulse waveforms to vigorous jumping motions, and motion-triggered Morse code communication. Crucially, addressing the hygiene concerns of reusable wearables, the membrane achieves rapid, non-contact sterilization during off-wear intervals. Under safe NIR irradiation (0.3 W cm-2), the surface temperature rises to ∼60 °C within 60 s, achieving an antibacterial efficacy of >99% against S. aureus and E. coli. Combined with excellent in vitro cytocompatibility, this work provides a "one-structure, dual-function" solution for constructing hygienic, high-performance electronic skins.
17 Apr 2026
Read appraisal →The New England journal of medicine
Selective Decontamination of the Digestive Tract during Ventilation in the ICU
BACKGROUND: Whether selective decontamination of the digestive tract (SDD) reduces mortality among patients undergoing mechanical ventilation and whether it adversely affects microbial ecology in the intensive care unit (ICU) remain unclear. In an earlier analysis of data from Australia, SDD did not result in a lower incidence of in-hospital death than standard care, but data from the full international trial are needed. METHODS: We randomly assigned ICUs in Australia and Canada to use SDD or to continue standard care for two 12-month periods in patients undergoing mechanical ventilation. Patients in the SDD group received specific oral and gastric antimicrobial interventions for the duration of ventilation and an intravenous antibiotic agent for the first 4 days after enrollment. All other patients in the ICU were included in an observational ecologic assessment. Previously reported data from Australia are now combined with data from Canada. The primary outcome was in-hospital death from any cause at 90 days. The secondary clinical outcomes, assessed at 90 days, were death in the ICU and the number of days alive and free of mechanical ventilation, ICU admission, and hospitalization. Microbiologic secondary outcomes included new positive cultures for bloodstream infections and antibiotic-resistant organisms. For the ecologic assessment, the microbiologic outcomes were tested for noninferiority (noninferiority margin, 2 percentage points). RESULTS: In this trial involving 20,000 patients in 26 ICUs, 9289 patients were enrolled in the randomized trial and 10,711 were included in the ecologic assessment. At 90 days, 1175 of 4215 patients (27.9%) in the SDD group and 1494 of 5065 (29.5%) in the standard-care group had died before hospital discharge (odds ratio, 0.94; 95% confidence interval [CI], 0.84 to 1.05; P = 0.27). New bloodstream infections occurred in 4.9% of the patients in the SDD group and in 6.8% of those in the standard-care group (adjusted mean difference, -1.30 percentage points; 95% CI, -2.55 to -0.05); antibiotic-resistant organisms were cultured in 16.8% and 26.8%, respectively (adjusted mean difference, -9.60 percentage points; 95% CI, -12.40 to -6.80). In the ecologic assessment, noninferiority of SDD was not confirmed for the development of new antibiotic-resistant organisms. Adverse events considered to be related to SDD or standard care were reported in 12 patients (0.3%) in the SDD group and in no patients in the standard-care group. Serious adverse events occurred in 47 patients (1.1%) and 59 patients (1.2%), respectively. CONCLUSIONS: Among critically ill patients undergoing mechanical ventilation, SDD did not result in a lower incidence of in-hospital death than standard care. (Funded by the National Health and Medical Research Council of Australia and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT02389036.).
16 Apr 2026
Read appraisal →Medicine
Effectiveness of Chinese herbal medicine mouthwash in preventing ventilator-associated pneumonia in patients with endotracheal intubation: A systematic review and meta-analysis
BACKGROUND: To systematically evaluate the effectiveness and safety of Chinese herbal medicine mouthwash (CHMM) in preventing ventilator-associated pneumonia (VAP) in patients with endotracheal intubation (ETT). METHODS: Computer searches were conducted for relevant randomized controlled trials (RCTs) in the China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chinese Scientific and Technical Journal Database (VIP), Chinese Biomedical Literature Database (SinoMed), PubMed, Embase, Cochrane Library, and CINAHL Database from the establishment to April 5, 2023. The data were analyzed by RevMan 5.3 software. The methodological quality of papers was evaluated by the Cochrane version 5.1.0 and the certainty of evidence was evaluated by the GRADE system. RESULTS: We included 27 RCTs with 2426 patients. Most of the included studies were of poor methodological quality. Meta-analysis showed that CHMM (RR = 0.41, 95% CI: 0.34-0.50, P < .00001, low-certainty evidence) or CHMM + routine oral care (RR = 0.31, 95% CI: 0.18-0.56, P < .0001) could reduce the incidence of VAP compared to non-CHMM. CHMM may be superior to saline (low-certainty evidence) and chlorhexidine (moderate-certainty evidence) in preventing VAP (P < .05). CONCLUSION: Low-certainty evidence shows that CHMM may be more advantageous in reducing the incidence of VAP compared to non-CHMM. However, due to some limitations and the low certainty of evidence, we cannot recommend CHMM for routine clinical use at this time. Large-scale and high-quality RCTs are also needed to definitively evaluate the safety and clinical benefits of CHMM in the future.
12 Apr 2026
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