GEM/cochrane-simplification huggingface dataset:
Abstract: We included eight cohort studies of which six were performed in primary care (total number of patients; n = 6622), one study was from an accident and emergency setting (n = 482), and one study was from a secondary care setting (n = 257). In the six primary care studies, the prevalence of spinal malignancy ranged from 0% to 0.66%. Overall, data from 20 index tests were extracted and presented, however only seven of these were evaluated by more than one study. Because of the limited number of studies and clinical heterogeneity, statistical pooling of diagnostic accuracy data was not performed. There was some evidence from individual studies that having a previous history of cancer meaningfully increases the probability of malignancy. Most "red flags" such as insidious onset, age > 50, and failure to improve after one month have high false positive rates. All of the tests were evaluated in isolation and no study presented data on a combination of positive tests to identify spinal malignancy. For most "red flags," there is insufficient evidence to provide recommendations regarding their diagnostic accuracy or usefulness for detecting spinal malignancy. The available evidence indicates that in patients with LBP, an indication of spinal malignancy should not be based on the results of one single "red flag" question. Further research to evaluate the performance of different combinations of tests is recommended.

Plain-language summary: Six family practice studies including over 6,600 back pain patients found 21 tumors (0.3%).  One study on back pain diagnosed in an emergency room and one on back pain in a spine clinic included 482 and 257 patients.  The family practice studies described 15 different questions and physical exam tests that have been used to screen for spinal tumors.  Most of the 15 were not accurate.  A previous history of cancer is a very useful indicator.  Other facts that may indicate cancer are age greater than 50, no prior history of back pain, and failure to improve after one month.  These are most likely useful when combined, or with other indicators such as a history of cancer.  By themselves, these three questions would result in over-testing of patients without cancer. The worst effects of low quality red flag screening are overtreatment and undertreatment.  If the tests are not accurate, patients without a tumor may get an x-ray, MRI, bone scan or CT scan that they don’t need—unnecessary exposure to x-rays, extra worry for the patient and extra cost.  At the other extreme (and much less common), it might be possible to miss a real tumor, and cause the patient to have extra time without the best treatment. Most of the studies were of low or moderate quality and did not use an MRI, the most accurate imaging test, to confirm the presence or absence of a tumor, so more research is needed to identify the best combination of questions and examination methods.
Abstract: We included two studies (one RCT and one CBA study) in this review (n = 311). Both of these studies indicated that a training workshop increased the knowledge about HIV/AIDS of traditional healers. With regards to behaviour change, Peltzer 2006 detected a significant difference in traditional healers' reports of managing their patients; however, there was no evidence of a reduction of HIV/STI risk behaviours and referral practices, as assessed by self-report. The study by Poudyal 2003 did not assess this outcome. Two studies met the inclusion criteria for this review. Although these studies reported some positive outcomes, the few studies and methodological heterogeneity limits the conclusions that can be drawn about the effectiveness of HIV training programs aimed at traditional healers. More rigorous studies (i.e. those employing rigorous randomisation procedures, reliable outcome measures and larger sample sizes) are needed to provide better evidence of the impact of HIV training programs aimed at traditional healers.

Plain-language summary: This review found four studies that evaluated the effectiveness of HIV/AIDS training programs aimed at traditional healers; information about two of these studies is not yet available. Both of these studies found that workshops improved traditional healer knowledge about HIV/AIDS. However, an assessment of behaviour change in one study found that a training program improved traditional healer behaviour in terms of managing patients, but not in reducing risky behaviours and referral practices. Although the studies evaluated reported some positive outcomes, they were not of high quality. It is therefore difficult to be certain about the efficacy of interventions for educating traditional healers in the fundamentals of STI and HIV medicine.
Abstract: Nineteen studies involving a total of 2,159 participants met criteria for inclusion. It was not possible to conduct a meta-analysis due to study heterogeneity with respect to populations, interventions, comparison groups, outcomes, and length of follow-up. Sample sizes ranged from 22 to 367. The populations studied ranged from general HIV-positive populations to studies focusing exclusively on children, women, Latinos, or adults with a history of alcohol dependence, to studies focusing almost exclusively on men. Study interventions included cognitive behavioral therapy, motivational interviewing, medication management strategies, and interventions indirectly targeting adherence, such as programs directed to reduce risky sexual behaviours. Ten studies demonstrated a beneficial effect of the intervention on adherence. We found that interventions targeting practical medication management skills, those administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence outcomes. We also found that interventions targeting marginalized populations such as women, Latinos, or patients with a past history of alcoholism were not successful at improving adherence. We were unable to determine whether effective adherence interventions were associated with improved virological or immunological outcomes. Most studies had several methodological shortcomings leaving them vulnerable to potential biases. We found evidence to support the effectiveness of patient support and education interventions intended to improve adherence to antiretroviral therapy. Interventions targeting practical medication management skills, those interventions administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence outcomes. There is a need for standardization and increased methodological rigour in the conduct of adherence trials.

Plain-language summary: This review identified 19 studies involving a total of 2,159 participants that evaluated an intervention intended to improve adherence. Ten of these studies demonstrated a beneficial effect of the intervention. We found that interventions targeting practical medication management skills, those administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence to antiretroviral therapy. We also found that interventions targeting marginalized populations such as women, Latinos, or patients with a past history of alcoholism were not successful at improving adherence. We did not find studies that evaluated the quality of the patient-provider relationship or the clinical setting. Most studies had several methodological shortcomings.
Abstract: Seven trials involving a total of 199 participants were included. A trial of adrenocorticotrophic hormone (43 participants) did not show any advantage compared with placebo for the treatment of ocular myasthenia gravis. Two double-blind trials compared prednisone with placebo for generalised myasthenia gravis. In the first (13 participants), the improvement was slightly greater in the prednisone group at six months. In the second (20 participants) which was a short-term trial, the improvement was significantly greater at two weeks. Two trials compared glucocorticosteroids with azathioprine (41 and 10 participants respectively). In one of these the rate of treatment failure was greater in the prednisone group. In a trial of glucocorticosteroids versus intravenous immunoglobulin (33 participants) no differences in treatment responses were encountered during a treatment period of 14 days. An open trial (39 participants) evaluating different corticosteroid doses revealed a shorter time to improvement in the high-dose group. None fulfilled the presently accepted standards of a high-quality trial. All these studies have risks of bias and have a weak statistical power. Limited evidence from randomised controlled trials suggests that corticosteroid treatment offers short-term benefit in myasthenia gravis compared with placebo. This supports the conclusions of observational studies and expert opinion. Limited evidence from randomised controlled trials does not show any difference in efficacy between corticosteroids and either azathioprine or intravenous immunoglobulin.

Plain-language summary: Seven randomised controlled trials which included in all 199 participants are published. None fulfilled the presently accepted standards of a high-quality trial. All these studies have risks of bias and have a weak statistical power. Limited evidence from randomised controlled trials suggests that corticosteroids offer short-term benefit compared with placebo (dummy treatment). This supports the conclusions of observational studies and expert opinion. Limited evidence from randomised controlled trials does not show any difference in efficacy between corticosteroids and either azathioprine or intravenous immunoglobulin. All trials had design flaws which limit the strength of the conclusions. Further randomised controlled trials are needed.
Abstract: Thirteen studies met the eligibility criteria of the review, randomising 2157 adults. Education significantly reduced future hospital admissions (RR 0.50; 95% CI 0.27 to 0.91, high quality evidence); however, the estimated reduction in risk of re-presentation at ED following intervention was imprecise and did not reach statistical significance (RR 0.72; 95% CI 0.47 to 1.11, low quality evidence). Symptom control improved following education. The lack of statistically significant differences between asthma education and control groups in terms of peak flow, quality of life, study withdrawal and days lost were hard to interpret given the low number of studies contributing to these outcomes and statistical variation between the study results. Two studies from the USA measured costs: one study from the early 1990s measured cost and found no difference for total costs and costs related to physician visits and admissions to hospital. If data were restricted to emergency department treatment, education led to lower costs than control. A study from 2009 showed that associated costs of ED presentation and hospitalisation were lower following educational intervention. Our findings support educational interventions applied in the emergency department as a means of reducing subsequent asthma admissions to hospital. Whilst the direction of the effect on ED presentations was consistent with the reduction in risk of admission, the results were not definitive.. Outcomes were measured on average at 6 months after index ED presentation. The impact of educational intervention in this context on longer term outcomes relating to asthma morbidity is unclear. Priorities for additional research in this area include assessment of health-related quality of life, lung function assessment, exploration of the relationship between socio-economic status and asthma morbidity, and better description of the intervention assessed.

Plain-language summary: We reviewed evidence from randomised trials that assessed an educational intervention given after presentation in the emergency setting by adults over 17 years old. Thirteen trials involving 2157 people were included. The studies suggested that following the intervention there was a reduction in the frequency of future hospital admissions; however, the effect on visit to the emergency department was imprecise and the results of our analysis indicate that this was a chance result. Education may be an effective reinforcement strategy in reducing future hospital admission following emergency department attendance, but there was little evidence to suggest that it improved other indicators of chronic disease severity such as lung function and quality of life.
Abstract: We included 24 studies (9,997 participants). Eighteen studies evaluated amiodarone for primary prevention and six for secondary prevention. Only three studies used an ICD concomitantly with amiodarone for the comparison (all of them for secondary prevention). For primary prevention, amiodarone compared to placebo or no intervention (17 studies, 8383 participants) reduced SCD (RR 0.76; 95% CI 0.66 to 0.88), cardiac mortality (RR 0.86; 95% CI 0.77 to 0.96) and all-cause mortality (RR 0.88; 95% CI 0.78 to 1.00). The quality of the evidence was low. Compared to other antiarrhythmics (three studies, 540 participants), amiodarone reduced SCD (RR 0.44; 95% CI 0.19 to 1.00), cardiac mortality (RR 0.41; 95% CI 0.20 to 0.86) and all-cause mortality (RR 0.37; 95% CI 0.18 to 0.76). The quality of the evidence was moderate. For secondary prevention, amiodarone compared to placebo or no intervention (two studies, 440 participants) appeared to increase the risk of SCD (RR 4.32; 95% CI 0.87 to 21.49) and all-cause mortality (RR 3.05; 1.33 to 7.01). However, the quality of the evidence was very low. Compared to other antiarrhythmics (four studies, 839 participants) amiodarone appeared to increase the risk of SCD (RR 1.40; 95% CI 0.56 to 3.52; very low quality of evidence), but there was no effect in all-cause mortality (RR 1.03; 95% CI 0.75 to 1.42; low quality evidence). Amiodarone was associated with an increase in pulmonary and thyroid adverse events. There is low to moderate quality evidence that amiodarone reduces SCD, cardiac and all-cause mortality when compared to placebo or no intervention for primary prevention, and its effects are superior to other antiarrhythmics. It is uncertain if amiodarone reduces or increases SCD and mortality for secondary prevention because the quality of the evidence was very low.

Plain-language summary: We searched scientific databases for clinical trials comparing the effects of amiodarone versus other antiarrhythmics or placebo on SCD, mortality and any side effects. We included adult participants at high risk or who had previously presented with sudden cardiac arrest, a serious heart malfunction that causes the arrhythmia. The evidence is current to March 2015. We found 24 studies comprising 9,997 participants. In participants at high risk, the evidence showed that amiodarone may prevent SCD or mortality when compared to placebo, and it is probably better than other antiarrhythmics. On the other hand, in participants who have already suffered a prior cardiac arrest, it is uncertain whether amiodarone increases or reduces the risk of a new episode of cardiac arrest or death. Furthermore, amiodarone may lead to or worsen adverse effects in the thyroid or lungs, when compared with placebo or other antiarrhythmics. The overall quality of evidence of these studies was low.
Abstract: Nine randomised controlled trials involving 395 patients were included. Six out of nine studies had a follow-up of less than one year, the longest study duration was 24 months. Only a third of the analysed studies revealed a low risk of bias. No information was available on quality of life, all-cause mortality and morbidity. Compared with conventional management, IGB did not show convincing evidence of a greater weight loss. On the other hand, complications of intragastric balloon placement occurred, however few of a serious nature. The relative risks for minor complications like gastric ulcers and erosions were significantly raised. Evidence from this review is limited for decision making, since there was large heterogeneity in IGB trials, regarding both methodological and clinical aspects. However, a co-adjuvant factor described by some authors in the loss and maintenance of weight has been the motivation and the encouragement to changing eating habits following a well-organized diet and a program of behavioural modification. The IGB alone and the technique of positioning appear to be safe. Despite the evidence for little additional benefit of the intragastric balloon in the loss of weight, its cost should be considered against a program of eating and behavioural modification.

Plain-language summary: Nine randomised controlled trials involving 395 patients were evaluated. Six out of nine studies had a follow-up of less than one year, the longest study duration was 24 months. The overall quality of trials was variable, only a third of the analysed studies showed a low risk of bias. No information was available on quality of life, all-cause mortality and morbidity. Compared with conventional management, IGB did not show convincing evidence of a greater weight loss. The relative risks for minor complications, for example gastric ulcers and erosions were significantly raised.
Abstract: No new trials were included from the 2012 search. The review still includes two trials of short duration comparing sulpiride with placebo (total n = 113). No study reported our primary outcome of interest of 'global state: clinically significant response', nor our secondary outcomes of interest of 'quality of life', 'severe adverse effects', and 'safety assessments'. As regards mental state, there were no clear differences between groups for either positive or negative symptoms; measured positive symptoms using the Manchester scale were skewed and therefore not included in meta-analysis (n = 18, 1 RCT, very low quality evidence). Measured negative symptoms using the Manchester scale also demonstrated no clear difference (n = 18, 1 RCT, MD -3.0 CI -1.66 to 1.06, very low quality evidence). Few people left these studies by three months (n = 113, 2 RCTs, RR 1.00 CI 0.25 to 4.00). One subscore finding demonstrated a significant improvement in social behaviour using the Current Behaviour Schedule (CBS) when receiving placebo (n = 18, 1 RCT, MD -2.90 CI -5.60 to -0.20). There were no data for many important outcomes such as global outcomes, service use or adverse effects. Sulpiride may be an effective antipsychotic drug but evidence of its superiority over placebo from randomised trials is very limited. Practice will have to use evidence from sources other than trials until better evidence is generated.

Plain-language summary: The aim of this review was to evaluate the effects of sulpiride for schizophrenia compared to placebo (‘dummy’ treatment). Two short-term (12 weeks) studies with a total of 113 people are included. Information was limited and poorly reported. The inclusion of two small studies with small sample sizes meant that resulting data were not overly robust or meaningful. Overall no clear difference was noted between those receiving sulpiride and those receiving placebo for mental state or for leaving the study early. There was no information on other important outcomes, including: general functioning, service use, hospital admission, employment, family burden, satisfaction with care and side effects. The use of sulpiride seems to be based on clinical experience rather than strong evidence. Its widespread use in developing countries might have more to do with its lower cost than its effectiveness. Longer, well-planned, better conducted and reported randomised control trials would contribute to our knowledge about the effectiveness and potential side effects of this drug. This plain language summary has been written by a consumer Benjamin Gray: Service User and Service User Expert: Rethink Mental Illness. Email: [email protected]
Abstract: Four controlled trials of 3,4-diaminopyridine compared with placebo in a total of 54 participants with Lambert-Eaton myasthenic syndrome were eligible: three cross-over trials and one parallel group. Two were added at this update. One of these trials also assessed pyridostigmine in conjunction with 3,4-diaminopyridine. A further cross-over trial compared intravenous immunoglobulin (IVIg) to placebo in nine participants. Four trials of 3,4-diaminopyridine reported significant improvement in the primary outcome, muscle strength score, or myometric limb measurement for between hours and a week following treatment, and significant improvement in resting compound muscle action potential (CMAP) amplitude following 3,4-diaminopyridine, compared with placebo. A meta-analysis of the primary endpoint showed Quantitative Myasthenia Gravis (QMG) muscle score assessed between three and eight days was likely to improve by a mean of 2.44 points (95% confidence interval 3.6 to 1.22). Meta-analysis of the secondary endpoint CMAP amplitude also showed a mean improvement of 1.36 mV (95% confidence interval 0.99 to 1.72) over the same period. The risk of bias was determined to be low, and quality of evidence moderate to high. A single cross-over trial reported significant improvement in myometric limb strength and non-significant improvement in mean resting CMAP amplitude with IVIg compared to placebo. Clinical improvement lasted for up to eight weeks. Limited but moderate to high quality evidence from randomised controlled trials showed that over days 3,4-diaminopyridine, or for up to 8 weeks IVIg, improved muscle strength scores and CMAP amplitudes in participants with Lambert-Eaton myasthenic syndrome. There are insufficient data at present to quantify this effect. Other possible treatments have not been tested in randomised controlled trials.

Plain-language summary: Four small randomised controlled trials involving 54 participants in total showed that 3,4-diaminopyridine improves muscle strength. This was determined by measuring the compound muscle action potential (CMAP) which is a test that records the amount of electrical activity generated in a muscle when it is stimulated by its nerve. Although the number of trials is relatively small, the quality of evidence from these trials is moderate to high, which supports the findings of this review. The changes are measured over days only. A single trial involving nine participants showed that intravenous immunoglobulin also improved muscle strength up to 8 weeks from treatment. Other possible treatments such as plasma exchange, steroids and immunosuppressive agents have not been tested in randomised controlled trials. Further trials of these treatments are needed.