GEM/cochrane-simplification huggingface dataset:
Abstract: We identified 15 RCTs of ICBI conducted in various settings and populations (3917 participants). Comparing ICBI to 'minimal interventions' such as usual practice, meta-analyses showed statistically significant effects as follows: moderate effect on sexual health knowledge (SMD 0.72, 95% CI 0.27 to 1.18); small effect on safer sex self-efficacy (SMD 0.17, 95% CI 0.05 to 0.29); small effect on safer-sex intentions (SMD 0.16, 95% CI 0.02 to 0.30); and also an effect on sexual behaviour (OR 1.75, 95% CI 1.18 to 2.59). Data were insufficient for meta-analysis of biological outcomes and analysis of cost-effectiveness. In comparison with face-to-face sexual health interventions, meta-analysis was only possible for sexual health knowledge, showing that ICBI were more effective (SMD 0.36, 95% CI 0.13 to 0.58). Two further trials reported no difference in knowledge between ICBI and face-to-face intervention, but data were not available for pooling. There were insufficient data to analyse other types of outcome. No studies measured potential harms (apart from reporting any deterioration in measured outcomes). ICBI are effective tools for learning about sexual health, and they also show positive effects on self-efficacy, intention and sexual behaviour. More research is needed to establish whether ICBI can impact on biological outcomes, to understand how interventions might work, and whether they are cost-effective.

Plain-language summary: We searched databases for studies which were randomised controlled trials (RCTs) of computer/Internet-based interventions which aimed to improve sexual health. We included trials of computer-based interventions delivered to people of any age, gender, sexual orientation, ethnicity or nationality. The review evaluated 15 RCTs involving 3917 participants. Results showed that computer-based interventions have a moderate effect in improving people's knowledge about sexual health in comparison to minimal interventions such as ‘usual practice' or a leaflet. We also found a small effect on safer sex self-efficacy (a person's belief in their capacity to carry out a specific action), a small effect on safer-sex intentions, and also an effect on sexual behaviour (such as condom use for sexual intercourse). We found that computer-based interventions seem better than face-to-face interventions at improving sexual health knowledge, but there were insufficient data to analyse other outcomes. No studies measured potential harms (apart from reporting any deterioration in outcomes). Interactive computer-based interventions for sexual health promotion are feasible in a variety of settings. They are effective tools for learning about sexual health, and they also improve self-efficacy, intention and sexual behaviour, but more research is needed to establish whether computer-based interventions can change outcomes such as sexually transmitted infections and pregnancy, to understand how interventions might work, and to assess whether they are cost-effective.
Abstract: A total of 703 unique items was identified. We included 19 RCTs. There was evidence of small study biases (Egger test, P = 0.002). In 15 placebo-controlled RCTs there was an effect of antibiotic prophylaxis (pooled RR 0.59, 95% CI 0.46 to 0.75, 95% PI 0.30 to 1.14, I2 = 39%). There were insufficient data (three trials) to determine whether one regimen was superior to another. In one trial, the incidence of post-abortal upper genital tract infection was higher in women allocated to the screen-and-treat strategy (RR 1.53, 95% CI 0.99 to 2.36). Antibiotic prophylaxis at the time of first trimester surgical abortion is effective in preventing post-abortal upper genital tract infection. Evidence of between trial heterogeneity suggests that the effect might not apply to all settings, population groups or interventions. This review did not determine the most effective antibiotic prophylaxis regimen. Antibiotic choice should take into account the local epidemiology of genital tract infections, including sexually transmitted infections. Further RCTs comparing different antibiotics or combinations of antibiotics with each other would be useful. Such trials could be done in low and middle income countries and where the prevalence of genital tract infections in women presenting for abortion is high.

Plain-language summary: We found 19 randomised controlled trials that looked at the effect of antibiotic prophylaxis on post-abortal upper genital tract infection amongst women requesting induced abortion in the first trimester of pregnancy. We looked at the effect of any antibiotic prophylaxis regimen on the outcome. Overall, the risk of post-abortal upper genital tract infection in women receiving antibiotics was 59% that of women who received placebo. There were, however, differences between the trial results over and above what would be expected by chance alone. It should be noted that, if the infection is caused by a sexually transmitted organism, antibiotic prophylaxis will not protect the woman from becoming re-infected if her sexual partner has not been treated. None of the trials was done in lower or middle income countries, which is where the risk of post-abortal complications is highest. Further trials are needed to determine whether combinations of antibiotics can prevent more infections than single antibiotics, or whether antibiotic prophylaxis should be restricted to women with positive results of screening tests before the abortion.
Abstract: We included two trials involving 312 infants. No data were available for correction of hypoglycaemia for each hypoglycaemic event. We found no evidence of a difference between dextrose gel and placebo gel for major neurosensory disability at two-year follow-up (risk ratio (RR) 6.27, 95% confidence interval (CI) 0.77 to 51.03; one trial, n = 184; quality of evidence very low). Dextrose gel compared with placebo gel or no gel did not alter the need for intravenous treatment for hypoglycaemia (typical RR 0.78, 95% CI 0.46 to 1.32; two trials, 312 infants; quality of evidence very low). Infants treated with dextrose gel were less likely to be separated from their mothers for treatment of hypoglycaemia (RR 0.54, 95% CI 0.31 to 0.93; one trial, 237 infants; quality of evidence moderate) and were more likely to be exclusively breast fed after discharge (RR 1.10, 95% CI 1.01 to 1.18; one trial, 237 infants; quality of evidence moderate). Estimated rise in blood glucose concentration following dextrose gel was 0.4 mmol/L (95% CI -0.14 to 0.94; one trial, 75 infants). Investigators in one trial reported no adverse outcomes (n = 237 infants). Treatment of infants with neonatal hypoglycaemia with 40% dextrose gel reduces the incidence of mother-infant separation for treatment and increases the likelihood of full breast feeding after discharge compared with placebo gel. No evidence suggests occurrence of adverse effects during the neonatal period or at two years' corrected age. Oral dextrose gel should be considered first-line treatment for infants with neonatal hypoglycaemia.

Plain-language summary: Two trials to date have assessed use of dextrose gel to reverse low blood glucose levels while the baby remains in the mother's care; these studies included a total of 312 infants. Investigators rubbed dextrose gel into the inside of the infant's cheek; they provided a normal feed for 157 of these infants and placebo gel plus a normal feed, or a normal feed alone, for 155 infants.Key results:Results suggest that dextrose gel is effective in keeping mothers and infants together and improving the rate of full breast feeding after discharge from hospital. Researchers reported no adverse effects when dextrose gel was given to infants and no effects on development at two years of age. The review is limited by lack of data for the important outcomes of effectiveness of treatment for individual episodes of low blood glucose levels and effects on brain injury. Further research is required to address these important questions. Dextrose gel applied to the inside of the cheek is a simple and safe treatment for initial care of infants with low blood glucose levels. Overall the quality of the evidence was moderate to very low. Reasons for downgrading the quality of evidence included imprecision (variation in data), publication bias (evidence based on data from a single trial; one publication in abstract format only), insufficient detail to allow a judgement about risk of bias and/or high levels of disagreement for a particular outcome.
Abstract: Of 3500 titles retrieved from the literature, 24 papers reporting on 23 studies could be included in the review. The studies were published between 1970 and 1997 and together included 1026 participants. Most were cross-over studies. Few studies provided sufficient information to judge the concealment of allocation. Four studies provided results for the percentage of symptom-free days. Pooling the results did not reveal a statistically significant difference between sodium cromoglycate and placebo. For the other pooled outcomes, most of the symptom-related outcomes and bronchodilator use showed statistically significant results, but treatment effects were small. Considering the confidence intervals of the outcome measures, a clinically relevant effect of sodium cromoglycate cannot be excluded. The funnel plot showed an under-representation of small studies with negative results, suggesting publication bias. There is insufficient evidence to be sure about the efficacy of sodium cromoglycate over placebo. Publication bias is likely to have overestimated the beneficial effects of sodium cromoglycate as maintenance therapy in childhood asthma.

Plain-language summary: In this review we aimed to determine whether there is evidence for the effectiveness of inhaled sodium cromoglycate as maintenance treatment in children with chronic asthma. Most of the studies were carried out in small groups of patients. Furthermore, we suspect that not all studies undertaken have been published. The results show that there is insufficient evidence to be sure about the beneficial effect of sodium cromoglycate compared to placebo. However, for several outcome measures the results favoured sodium cromoglycate.
Abstract: Three studies (866 participants) compared rectally administered sumatriptan with placebo or an active comparator. Most of the data were for the 12.5 mg and 25 mg doses. For the majority of efficacy outcomes, sumatriptan surpassed placebo. For sumatriptan 12.5 mg versus placebo the NNTs were 5.2 and 3.2 for headache relief at one and two hours, respectively. Results for the 25 mg dose were similar to the 12.5 mg dose, and there were no significant differences between the two doses for any of the outcomes analysed. The NNTs for sumatriptan 25 mg versus placebo were 4.2, 3.2, and 2.4 for pain-free at two hours, headache relief at one hour, and headache relief at two hours, respectively. Relief of functional disability was greater with sumatriptan than with placebo, with NNTs of 8.0 and 4.0 for the 12.5 mg and 25 mg doses, respectively. For the most part, adverse events were transient and mild and were more common with sumatriptan than with placebo, but there were insufficient data to perform any analyses. Direct comparison of sumatriptan with active treatments was limited to one study comparing sumatriptan 25 mg with ergotamine tartrate 2 mg + caffeine 100 mg. Based on limited amounts of data, sumatriptan 25 mg, administered rectally, is an effective treatment for acute migraine attacks, with participants in these studies experiencing a significant reduction in headache pain and functional disability within two hours of treatment. The lack of data on relief of headache-associated symptoms or incidence of adverse events limits any conclusions that can be drawn.

Plain-language summary: This review found that a single dose administered rectally was effective in relieving migraine headache pain and functional disability. Pain was reduced from moderate or severe to no pain by two hours in approximately 2 in 5 people (41%) taking sumatriptan 25 mg, compared with about 1 in 6 (17%) taking placebo. Pain was reduced from moderate or severe to no worse than mild pain by two hours in roughly 2 in 3 people (71%) taking sumatriptan 25 mg, compared with approximately 1 in 3 (30%) taking placebo. In addition to relieving headache pain, sumatriptan 25 mg also relieved functional disability by two hours in about 2 in 5 people (41%), compared with about 1 in 6 (16%) taking placebo. There was not enough evidence to draw any conclusions about the incidence of adverse events or to compare rectal sumatriptan directly with any other active comparators.
Abstract: Six studies involving 1001 women were included. Three trials compared one counselling session with no counselling. There was no significant difference in psychological well being including anxiety, grief, depression avoidance and self-blame. One trial compared three one-hour counselling sessions with no counselling at four and 12 months. Some subscales showed statistical significance in favour of counselling and some in favour of no counselling. The results for two trials were given in narrative form as data were unavailable for meta-analyses. One trial compared multiple interventions. The other trial compared two counselling sessions with no counselling. Neither study favoured counselling. Evidence is insufficient to demonstrate that psychological support such as counselling is effective post-miscarriage. Further trials should be good quality, adequately-powered using standardised interventions and outcome measures at specific time points. The economic implications and women's satisfaction with psychological follow-up should also be explored in any future study.

Plain-language summary: Miscarriage is the premature, or loss of a fetus, up to 23 weeks of pregnancy. Some women suffer from anxiety and depression after miscarriage which may be part of their grief following the loss. Psychological follow-up might detect those women who are at risk of psychological complications following miscarriage. This review of six studies, involving 1001 women, found that there is insufficient evidence from randomised controlled trials to recommend any method of psychological follow-up. Timing of the counselling interventions varied from one week following miscarriage up to 11 weeks. In all studies the interventions were delivered by different professional groups including a midwife, psychologists and nurses. Measurements of the outcomes were made from one month to 12 months after miscarriage in the different studies, which highlights the uncertainty surrounding the rate of psychological recovery following miscarriage. The two larger studies included a complex combination of interventions and outcome measures so that any potentially significant effects may have been diluted. Further robust research is needed to determine if any recognised psychological follow-up is effective is hastening psychological recovery following miscarriage.
Abstract: In this review, we included a total of five studies comparing supervised walking exercise and alternative modes of exercise. The alternative modes of exercise therapy included cycling, strength training, and upper-arm ergometry. The studies represented a sample size of 135 participants with a low risk of bias. Overall, there was no clear evidence of a difference between supervised walking exercise and alternative modes of exercise in maximum walking distance (8.15 METs, 95% confidence interval (CI) -2.63 to 18.94, P = 0.14, equivalent of an increase of 173 metres, 95% CI -56 to 401) on a treadmill with no incline and an average speed of 3.2 km/h, which is comparable with walking in daily life. Similarly, there was no clear evidence of a difference between supervised walking exercise and alternative modes of exercise in pain-free walking distance (6.42 METs, 95% CI -1.52 to 14.36, P = 0.11, equivalent of an increase of 136 metres, 95% CI -32 to 304). Sensitivity analysis did not alter the results significantly. Quality of life measures showed significant improvements in both groups; however, because of skewed data and the very small sample size of the studies, we did not perform a meta-analysis for health-related quality of life and functional impairment. There was no clear evidence of differences between supervised walking exercise and alternative exercise modes in improving the maximum and pain-free walking distance of patients with intermittent claudication. More studies with larger sample sizes are needed to make meaningful comparisons between each alternative exercise mode and the current standard of supervised treadmill walking. The results indicate that alternative exercise modes may be useful when supervised walking exercise is not an option for the patient.

Plain-language summary: The present review shows that there are few studies comparing alternative modes of exercise training to the standard of supervised walking exercise. The review authors identified five studies that randomised a total of 135 participants. The alternative modes of exercise therapy included cycling, strength training, and upper-arm ergometry. Comparing these alternative modes of exercise with supervised walking exercise showed no clear evidence of a difference in maximum or pain-free walking distance between the groups. Quality of life measures showed significant improvements in both groups; however, we could not make a direct comparison because of limited data. This review shows that alternative modes of exercise therapy seem to yield similar results to supervised walking therapy. Therefore, they may be considered useful when supervised walking exercise is not an option for the patient. However, more randomised controlled trials are needed to make a meaningful comparison between the different modes of exercise therapy.
Abstract: Thirteen trials (n=1154) investigated external beam radiotherapy with dosages ranging from 7.5 to 24 Gy; one additional trial (n=88) used plaque brachytherapy (15Gy at 1.75mm for 54 minutes/12.6 Gy at 4mm for 11 minutes). Most studies found effects (not always significant) that favoured treatment. Overall there was a small statistically significant reduction in risk of visual acuity loss in the treatment group. There was considerable inconsistency between trials and the trials were considered to be at risk of bias, in particular because of the lack of masking of treatment group. Subgroup analyses did not reveal any significant interactions, however, there were small numbers of trials in each subgroup (range three to five). There was some indication that trials with no sham irradiation in the control group reported a greater effect of treatment. The incidence of adverse events was low in all trials; there were no reported cases of radiation retinopathy, optic neuropathy or malignancy. Three trials found non-significant higher rates of cataract progression in the treatment group. This review currently does not provide convincing evidence that radiotherapy is an effective treatment for neovascular AMD. If further trials are to be considered to evaluate radiotherapy in AMD then adequate masking of the control group must be considered.

Plain-language summary: This review identified 14 randomised controlled trials of radiotherapy for wet AMD. Most of these trials showed effects (not always significant) that favoured treatment with radiotherapy to prevent vision loss. However, overall this review does not provide convincing evidence that radiotherapy is an effective treatment for wet AMD, in part because the results of different trials were inconsistent, but also because it is possible that the treatment effects could be explained by the fact that it was not possible to mask the participants, and people measuring outcome, to the treatment group. The incidence of adverse effects reported in these trials was low - nobody developed any radiation-specific side effects although in three trials higher rates of cataract were reported in the radiotherapy group.
Abstract: Seven heterogeneous English language RCTs with reasonable quality were included. Three small studies (168 people) separately showed statistically significant but clinically unimportant pain relief for LLLT versus sham therapy for sub-acute and chronic low-back pain at short-term and intermediate-term follow-up (up to six months). One study (56 people) showed that LLLT was more effective than sham at reducing disability in the short term. Three studies (102 people) reported that LLLT plus exercise were not better than exercise, with or without sham in the short-term in reducing pain or disability. Two studies (90 people) reported that LLLT was not more effective than exercise, with or without sham in reducing pain or disability in the short term. Two small trials (151 people) independently found that the relapse rate in the LLLT group was significantly lower than in the control group at the six-month follow-up. No side effects were reported. Based on the heterogeneity of the populations, interventions and comparison groups, we conclude that there are insufficient data to draw firm conclusions on the clinical effect of LLLT for low-back pain. There is a need for further methodologically rigorous RCTs to evaluate the effects of LLLT compared to other treatments, different lengths of treatment, wavelengths and dosages.

Plain-language summary: We included seven small studies with a total of 384 people with non-specific LBP of varying durations. Three studies (168 people) separately showed that LLLT was more effective at reducing pain in the short-term (less than three months), and intermediate-term (six months) than sham (fake) laser. However, the strength and number of treatments were varied and the amount of the pain reduction was small. Three studies (102 people) separately reported that LLLT with exercise was not better than exercise alone or exercise plus sham in short-term pain reduction. One study (56 people) showed that LLLT was more effective than sham at reducing disability in the short term. Three studies (102 people) compared LLLT plus exercise with exercise plus sham or exercise alone and did not show significant reduction in disability. Two studies (90 people) separately reported that LLLT was not more effective at reducing disability than exercise alone or exercise plus sham in the short-term. Based on these small trials, with different populations, LLLT doses and comparison groups, there are insufficient data to either support or refute the effectiveness of LLLT for the treatment of LBP. We were unable to determine optimal dose, application techniques or length of treatment with the available evidence. Larger trials that look specifically at these questions are required.