Background:An abnormal hemoglobin concentration has a substantial effect on a person's quality of life and physiology. Lack of tools that effectively evaluate hemoglobin-related outcomes leads to... Show moreBackground:An abnormal hemoglobin concentration has a substantial effect on a person's quality of life and physiology. Lack of tools that effectively evaluate hemoglobin-related outcomes leads to uncertainty regarding optimal hemoglobin levels, transfusion thresholds and treatment targets. We therefore aim to summarize reviews that assess the effects of hemoglobin modulation on the human physiology at various baseline hemoglobin levels, and identify gaps in existing evidence. Methods:We conducted an umbrella review of systematic reviews. PubMed, MEDLINE (OVID), Embase, Web of Science, Cochrane Library and Emcare were searched from inception to the 15th of April 2022 for studies that reported on physiological and patient reported outcomes following a hemoglobin change. Results:Thirty-three reviews were included of which 7 were scored as of high quality and 24 of critically low quality using the AMSTAR-2 tool. The reported data generally show that an increase in hemoglobin leads to improvement of patient reported and physical outcomes in anaemic and non-anaemic subjects. At lower hemoglobin levels, the effect of a hemoglobin modulation on quality of life measures appears more pronounced. Conclusion:This overview has revealed many knowledge gaps due to a lack of high-quality evidence. For chronic kidney disease patients, a clinically relevant benefit of increasing the hemoglobin levels up until 12 g/dL was found. However, a personalized approach remains necessary due to the many patient-specific factors that affect outcomes. We strongly encourage future trials to incorporate physiological outcomes as objective parameters together with subjective, but still very important, patient reported outcome measures. Show less
Cuijpers, P.; Miguel, C.; Ciharova, M.; Aalten, P.; Batelaan, N.; Salemink, E.; ... ; Karyotaki, E. 2021
We conducted an umbrella review of 31 meta-analyses with 608 primary studies, examining the effects of psychological interventions for prevention and treatment of mental and psychological problems... Show moreWe conducted an umbrella review of 31 meta-analyses with 608 primary studies, examining the effects of psychological interventions for prevention and treatment of mental and psychological problems in college students. The proportion of unique primary studies included in the meta-analyses ranged from 6 to 100%. For problems like depression, anxiety, and stress, effective universal, indicated, and treatment interventions are available. For alcohol problems effects are small and it is not clear if these are clinically relevant. Effective interventions have been developed for smoking cessation, test-anxiety, internet addiction, procrastination, and bystander sexual assault prevention programs. The quality of most metaanalyses and almost all primary studies was suboptimal. Therefore, all findings have to be considered with caution. Show less
