flowchart TD;
        search_db["Records identified through database searching (n=1749)"] --> starting_sample;
        search_prev["Records identified through other sources (n=2240)"] --> starting_sample["Starting sample (n=3989)"];

        starting_sample -- "Duplicate removal (267 removed) "--> dedup["Records after duplicates removed (n=3723)"];

        dedup -- "Title screening (1779 excluded)" --> title_screened["Records after titles screened (n=1944)"];

        title_screened -- "Abstract screening (1506 excluded)"--> abstract_screened["Records after abstracts screened (n=438)"];

        abstract_screened -- "  Language screening (2 excluded)  "--> language_screened["Records after language screened (n=436)"];

        language_screened -- "  Full-text screening (383 excluded)  "--> full-text_screened["Full-text articles assessed for eligibility (n=52)"];