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Background. Low back pain (LBP) is considered the leading cause of people living with years of disability worldwide. Notably, thunder-fire moxibustion (TFM) is a new type of moxibustion, which has been widely applied to treat pain syndromes for thousands of years. This study aims to provide evidence to evaluate the effect and safety of TFM in treating LBP. Methods. A systematic search of PubMed, Web of Science, the Cochrane Library, Embase, EBSCO, CNKI, Wanfang Data, CBM, and VIP (until April 2021) was used to identify studies reporting pain intensity, disability, Japanese Orthopedic Association (JOA) score, and quality of life in patients with LBP. Randomized controlled trials (RCTs), which compared TFM and other therapies in LBP, were included. Meanwhile, methodological quality was evaluated using the Cochrane criteria for risk of bias, and the level of evidence was rated utilizing the GRADE approach. Results. Twenty-one RCTs, including 2198 patients, satisfied the inclusion criteria. Compared with other therapies, the effect of TFM was statistically significant, pain intensity decreased (SMD = 0.94; 95% CI (0.74, 1.14); p < 0.00001), disability improved (SMD = 1.39; 95% CI (0.19, 2.59); p = 0.02), and the JOA score increased (SMD = −1.34; 95% CI (−1.88, −0.80); p < 0.00001). It was also reported that the patient's quality of life improved after treatment for a period of 4 weeks (SMD = −0.29; 95% CI (−0.42, −0.16); p < 0.0001) and after a follow-up of 1 month (SMD = −0.20; 95% CI (−0.34, −0.07); p = 0.003). The evidence level of the results was determined to be very low to low. Conclusions. Based on the existing evidence, it can be concluded that TFM may have a better effect than other treatments on LBP. However, it is not yet possible to assess the safety level of TFM therapy. Due to the universal low quality of the eligible trials and low evidence level, rigorously designed large-scale RCTs must be conducted in order to further confirm the results in this review. [ABSTRACT FROM AUTHOR]

Introduction Moxibustion is widely used in China and other East Asian countries to manage the symptom of rheumatoid arthritis (RA) and to lessen the adverse effects of western medicine. The purpose of this systematic review was to evaluate the available evidence from randomized controlled trials (RCTs) of moxibustion for treating patients with rheumatoid arthritis (RA). Methods Seven Chinese and English databases were searched to November 2013 from their inception. Eligible RCTs were included if moxibustion was used either alone or in combination with Western medicine for treating rheumatoid arthritis. Study selection, data extraction, and validation was performed independently by two reviewers. Cochrane criteria for risk of bias was used to assess the methodological quality of the trials. Results Eight RCTs met the inclusion criteria, and most were of low methodological quality. Meta-analysis showed favorable effects of moxibustion on the response rate, either alone [RR = 1.18, 95%CI (1.03, 1.35), p = 0.02; heterogeneity: Chi 2 = 1.11, p = 0.77, I 2 = 0%] or the combination with Western medicine therapy [RR = 1.28, 95%CI (1.12, 1.47), p = 0.0004; heterogeneity: Chi 2 = 1.96, p = 0.58, I 2 = 0%]. When compared with Western medicine therapy, Western medicine plus moxibustion therapy showed a favorable statistically significant effect on a reduction on American College of Rheumatology (ACR) 50 [RR = 1.57, 95%CI (1.25, 1.99), p = 0.0001; heterogeneity: Chi 2 = 2.87, p = 0.58, I 2 = 0%], whereas it failed to do so on American College of Rheumatology (ACR) 20. Additionally, when compared with western medicine therapy alone, meta-analysis of three RCTs suggested favorable but no statistically significant effects of moxibustion plus western medicine on the control of disease activities of rheumatoid arthritis. Conclusions It is difficult to draw firm conclusions on whether moxibustion is an effective intervention for treating RA due to the small sample size of eligible RCTs and the high risk of bias among the available RCTs. Further rigorous RCTs are warranted but need to overcome methodological shortcomings of the existing evidence. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes.Objective: The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time.Methods: We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment.Results: A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, P<.001, I2=47%). However, there was no difference between VR and the control conditions in skills (SMD=0.01, 95% CI -0.24 to 0.26, P=.93, I2=37%), satisfaction (SMD=0.01, 95% CI -0.79 to 0.80, P=.99, I2=86%), confidence (SMD=0.00, 95% CI -0.28 to 0.27, P=.99, I2=0%), and performance time (SMD=-0.55, 95% CI -2.04 to 0.94, P=.47, I2=97%).Conclusions: The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results. [ABSTRACT FROM AUTHOR]

To systematically review and meta-analyze the efficacy of moxibustion in treating patients with chronic low back pain (CLBP). A systematic search of the Cochrane Library, Web of Science, PubMed, Embase, EBSCO, CBM, Wanfang, CNKI and VIP (until November, 2019) was used to identify studies reporting pain intensity (VAS or NRS), disability (ODI or RMDQ), JOA score, and quality of life (SF-36) in patients with CLBP. Study selection, data extraction was performed critically and independently by two reviewers. Cochrane criteria for risk of bias was used to assess the methodological quality of the trials. The Grading of Recommendations Assessment, Development, and Evaluation Methodology (GRADE) was applied to test the quality of evidence from the quantitative analysis. Ten RCTs, including 987 patients, met the inclusion criteria. Moxibustion had a superior effect on VAS score when compared with western medicine [RR = −1.69, 95%CI(-2.40, −0.98), p < 0.00001] and acupuncture [RR = −0.47, 95%CI(-0.92, −0.02), p= 0.04], but it failed to do so when compared with core stability training [RR = −0.41, 95%CI(-0.87, 0.05), p= 0.08]. The result showed that moxibustion plus other active treatments (including western medicine, massage, acupuncture and core stability training) had better effects on low back pain relief compared with active treatments alone. Moxibustion showed favourable effects on disability [SMD = −3.80, 95%CI (−5.49, −2.11), p < 0.0001], JOA score [MD = 4.10, 95%CI(2.30, 5.90), p < 0.00001], and SF-36 score [MD = 13.41, 95%CI(9.68, 17.14), p < 0.00001]. The evidence level of the results from the ten studies was determined to be very low to low. It is difficult to draw firm conclusions that moxibustion is an effective intervention for treating CLBP due to the small sample size of eligible trails and the high risk of bias among the available articles. Rigorously designed large-scale RCTs are required to further confirm the results in this review. • We first meta-analyze the effects of moxibustion on CLBP in 4 outcomes. • Subgroup analysis was performed based on various interventions. • Results showed moxibustion may have favourable effects on CLBP. • GRADE shows that quality of evidence is very low to low. • The effects of moxibustion is inconclusive due to low quality evidence. [ABSTRACT FROM AUTHOR]

Objective: A systematic review and analysis of data from several rheumatoid arthritis metabolomics studies attempts to determine which metabolites can be used as potential biomarkers for the diagnosis of rheumatoid arthritis and to explore the pathogenesis of rheumatoid arthritis.Methods: We searched all the subject-related documents published by EMBASE, PubMed, Web of Science, and Cochrane Library from the database to the September 2019 publication. Two researchers independently screened the literature and extracted the data. QUADOMICS tool was used to assess the quality of studies included in this systematic review.Results: A total of 10 studies met the inclusion criteria of systematic review, including 502 patients with rheumatoid arthritis and 373 healthy people. Among them, the biological samples utilised for metabolomic analysis include: serum (n=8), urine (n=1) and synovial fluid (n=1). Some metabolites play an important role in rheumatoid arthritis: glucose, lactic acid, citric acid, leucine, methionine, isoleucine, valine, phenylalanine, threonine, serine, proline, glutamate, histidine, alanine, cholesterol, glycerol, and ribose.Conclusions: Metabolomics provides important new opportunities for further research in rheumatoid arthritis and is expected to elucidate the pathogenesis of rheumatoid arthritis that has not been fully understood before. [ABSTRACT FROM AUTHOR]