Background and Objectives: Advanced non-small-cell lung cancer (NSCLC) has led to a high number of mortalities. Immunotherapy, as a first-line treatment in advanced NSCLC, currently has no clarity regarding its prognostic markers to assess the treatment outcome. This systematic review aimed to evaluate neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic markers in advanced NSCLC patients treated with immunotherapy. Materials and Methods: This systematic review was conducted using the PRISMA guidelines, starting from screening for relevant studies from several databases. Each included cohort study was further assessed by using the Newcastle–Ottawa Quality Assessment Scale, and the available data were extracted for qualitative and quantitative synthesis in pooled and subgroup analysis. Results: A total of 1719 patients were included in this meta-analysis. Hazard ratio (HR) outcomes for progression-free survival (PFS) and overall survival (OS) for NLR and PLR showed significant results, supporting NLR and PLR as prognostic markers (NLR: HR PFS 2.21 [95% CI: 1.50–3.24; p < 0.0001] and HR OS 2.68 [95% CI: 2.24–3.6; p < 0.0001]; PLR: HR PFS 1.57 [95% CI: 1.33–1.84; p < 0.00001] and HR OS 2.14 [95% CI: 1.72–2.67; p < 0.00001]). Subgroup analysis with a cut-off value of 5 for NLR and 200 for PLR also demonstrated notable outcomes. Higher NLR and PLR levels are associated with poor prognostic. Conclusions: There is considerable evidence regarding both markers as prognostic markers in NSCLC patients treated with immunotherapy. However, further studies with more homogeneous baseline characteristics are required to confirm these findings.
Background: Depression and anxiety have become the most common mental health disorders worldwide during the COVID-19 pandemic, and increasing interest in telemedicine has led to the innovation of using internet-based cognitive behavioral therapy (iCBT). Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of iCBT for depression and anxiety among the global population during the COVID-19 pandemic. Methods: A literature search was conducted on PubMed, Scopus, Cochrane, ProQuest, Wiley, and Web of Science using the PRISMA framework, and only randomized controlled trials (RCTs) were included in the study. A critical appraisal was also performed using Cochrane’s Risk of Bias (RoB) 2. The meta-analysis used random-effects models to analyze pooled mean difference (MD) and its p-value. Results: Twelve RCTs were included for qualitative analysis and nine RCTs, which yielded 6778 patients with depression and 6556 patients with anxiety during the COVID-19 pandemic, were included for quantitative analysis. Despite high heterogeneity, all studies had a low risk of bias. Pre- and post-iCBT intervention in the depression forest plot depicts a significant effect (p < 0.00001) with a pooled MD of 4.73 (95% CI: 4.55–4.90), while the pre- and post-iCBT intervention depicts a significant effect (p < 0.00001) with a pooled MD of 4.50 (95% CI: 4.34–4.67). This demonstrates that iCBT was found to significantly decrease depression and anxiety scores in patients during the COVID-19 pandemic. However, substantial heterogeneity was also found (I2 = 93%; p < 0.00001 and I2 = 90%) for the pre-/post-depression and anxiety forest plots, respectively. Conclusions: This meta-analysis comprises an evidence-based result for iCBT to treat depression and anxiety in the COVID-19 population, as indicated by the significantly lower assessment scores. Delivering iCBT in this situation needs to be considered more extensively, as it has promising results and yields the benefits of technological advancement in psychotherapy.
Background and objective: Patients with heart failure are a high-risk group who may have a higher mortality rate if infected during the COVID-19 pandemic. The problem of a patient’s non-adherence to cardiac rehabilitation programs is still a challenge, resulting in disappointing long-term benefits of cardiac rehabilitation. Telehealth, including telerehabilitation, has grown in popularity to improve access to quality healthcare. It is more valuable and safer compared to usual rehabilitation care, especially during the current COVID-19 pandemic, to cut down unnecessary hospital visits and reduce the risk of cluster infections. This study aims to identify the efficacy of relevant randomized control trials (RCTs) using telerehabilitation in managing heart failure. The model, delivery care, safety, and efficacy were assessed. Material and Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). The authors included relevant records published in the last ten years from three databases: PubMed/MEDLINE, ProQuest, and EBSCO. Each included study was further assessed using Cochrane’s Risk of Bias (Rob 2) tool. Results: The telerehabilitation models consisted of cellphones, instant messaging, or online videoconferencing software. Some also included tool sets to monitor patients’ vital signs regularly or during exercise. Most patients adhered to and completed all provided programs. Cardiac telerehabilitation successfully improved patients’ physical fitness, quality of life, and mental health. No major adverse outcomes or significant complications were associated with the program. Conclusion: Cardiac telerehabilitation has the potential to deliver rehabilitation for heart failure patients, evidenced by its feasibility, efficacy, and safety. As a future perspective, this delivery care type can be applied throughout transmissible disease outbreaks or even globally.
COVID-19 has caused widespread psychological suffering. Anxiety is one of the several psychological disorders that are escalating globally, yet social distance constraints restrict in-person mental health therapy. Anxiety and other psychological disorders whose treatments are limited due to social distancing continue to grow, so there is an increasing need to use mental healthcare that can be offered remotely, especially in the pandemic era. This study aimed to conduct a systematic review and meta-analysis of the efficacy of online-based interventions for anxiety during COVID-19. This study followed the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA). We collected data from three databases, namely PubMed, CINAHL, and Oxford Library Press, published in 2020–2022. Additionally, we collected data using the snowball technique. This meta-analysis analyzed the pooled mean difference (MD) and its p-value using random-effects models. Critical appraisal and risk of bias were assessed using Cochrane Risk of Bias (Rob) 2. We retrieved 34 RCTs for systematic review and 14 RCTs for meta-analysis, yielding 9159 participants for general anxiety disorder (GAD-7) measurement and 1303 participants for depression anxiety stress scale (DASS-21) measurement. This study shows that online-based interventions significantly reduce GAD-7 score (a pooled MD of 1.30; 95% CI: 2.83–4.65; p = 0.00001) and insignificantly reduce DASS-21 (0.05; 95% CI: −2.63–2.72; p = 0.97) according to pre- and post-test in intervention group. Additionally, there is a significant difference between the intervention and control groups, where the intervention group performed statistically progressively better than the controls (−7.26; 95% CI: −11.58–−2.95; p = 0.001) (−2.08; 95% CI: −6.71–2.55; p = 0.001). Online-based interventions have proved effective for reducing general anxiety during the COVID-19 pandemic. Consequently, this meta-analysis can be adapted as a model for mental health services in the new normal.
Background: In response to the need for safe care for people with diabetes mellitus in the current outbreak of COVID-19, it is critical to evaluate the model, service delivery, feasibility, and efficiency of diabetes mellitus telecoaching. Objective: This study aimed to conduct a systematic review and meta-analysis of the model and efficacy of telecoaching to improve self-care and clinical outcomes. Methods: This study uses the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA). We searched on 22 March 2022, using keywords that matched the MeSH browser in four databases to find relevant studies, namely, PubMed/Medline, Proquest, Scopus, and EBSCOhost. Additionally, we collected randomized controlled trials (RCTs) on Google Scholar using the snowball technique. A quality assessment was performed using the Cochrane Collaboration’s Risk of Bias tool (RoB)2. The meta-analysis used the DerSimonian–Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. Results: Thirteen RCT studies were included for the systematic review and meta-analysis with a total number of participants of 3,300. The model of telecoaching is a form of using nurses-led telephone and mobile apps, which are relatively cost-effective. The meta-analysis showed a positively improved statistically significance in clinical outcomes, including in HbA1c (a pooled MD of −0.33; 95% CI: −0.51–−0.15; p = 0.0003), blood glucose (−18.99; 95% CI: −20.89–−17.09; p = 0.00001), systolic blood pressure (−2.66; 95% CI: −3.66–−1.66; p = 0.00001), body mass index (−0.79; 95% CI: −1.39–−0.18; p = 0.01), and weight (−2.16 kg; 95% CI: −3.95–−0.38; p = 0.02). It was not, however, statistically significant in diastolic blood pressure (−0.87; 95% CI: −2.02–0.28; p = 0.14), total cholesterol (−0.07; 95% CI: −0.26–0.12; p = 0.46), low-density lipoprotein (−2.19; 95% CI: −6.70–2.31; p = 0.34), triglycerides (−13.56; 95% CI: −40.46–13.35; p = 0.32) and high-density protein (0.40; 95% CI: −1.12–1.91; p = 0.61). Conclusions: The telecoaching with nurses-led telephone and mobile apps significantly affected clinical outcomes on HbA1c, systolic blood pressure, weight, and BMI. Moreover, there was no significant effect on the total cholesterol, low-density lipoprotein, triglycerides, and high-density lipoprotein. Thus, telecoaching has the potential as a care model in diabetes mellitus during COVID-19 and similar pandemics to improve self-care and clinical outcomes, but all the studies analyzed involved non-COVID-19 patients, limiting the generalizability of the results to COVID-19.
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