Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial. Impact of Chlorhexidine Pretreatment Followed by Probiotic Streptococcus salivarius Strain K12 on Halitosis in Children: A Randomised Controlled Clinical Trial. Oral probiotics reduce halitosis in patients wearing orthodontic braces: a randomized, triple-blind, placebo-controlled trial. Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: A randomized controlled trial Probiotic Therapy of the Irritable Bowel Syndrome: Why Is the Evidence Still Poor and What Can Be Done About It? Probiotics and prebiotics in gastrointestinal disorders Mixed treatment comparison analysis provides internally coherent treatment effect estimates based on overviews of reviews and can reveal inconsistency. The politics of probiotics: probiotics, necrotizing enterocolitis and the ethics of neonatal research Probiotics in Treatment of Allergic Rhinitis INVITED COMMENTARY: Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions A Systematic Review of Probiotic Interventions for Gastrointestinal Symptoms and Irritable Bowel Syndrome in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics Efficacy and safety of acupuncture for hypertension: An overview of systematic reviews. Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview Elusive search for effective provider interventions: a systematic review of provider interventions to increase adherence to evidence-based treatment for depression Overview of Reviews The prevention of eczema in infants and children: an overview of Cochrane and non-Cochrane reviews. Systematic review automation technologies Effects of self-ligating and conventional brackets on halitosis and periodontal conditions. A systematic review of randomized controlled trials on curative and health enhancement effects of forest therapy Effect of photodynamic therapy for the treatment of halitosis in adolescents - a controlled, microbiological, clinical trial. The effect of oil pulling with rice bran oil, sesame oil, and chlorhexidine mouth rinsing on halitosis among pregnant women: A comparative interventional study Are probiotics safe for use during pregnancy and lactation?
OBJECTIVE The objective of this study was to evaluate whether oral administration of lactobacilli alters the degree of halitosis and clinical conditions associated with halitosis . STUDY DESIGN Twenty patients with genuine halitosis were given 2.0 x 10(9)Lactobacillus salivarius WB21 and xylitol in tablet form daily .  Oral malodor and clinical parameters were evaluated at the same time of day for each patient after 2 and 4 weeks . RESULTS All 20 patients were positive for L. salivarius DNA in their saliva at 2 weeks , although 12 patients were negative for this organism at baseline . Oral malodor parameters significantly decreased at 2 weeks in the subjects with physiologic halitosis . The scores of an organoleptic test and bleeding on probing significantly decreased at 4 weeks in the subjects with oral pathologic halitosis . CONCLUSIONS Oral administration of probiotic lactobacilli primarily improved physiologic halitosis and also showed beneficial effects on bleeding on probing from the periodontal pocket PURPOSE The aim of this study was to examine the effect of chlorhexidine disinfection , as a chemical method of oral hygiene practice , and subsequent use of probiotics on  halitosis in children . The effects of mechanical and chemical oral hygiene practice methods on the severity of halitosis were also assessed . MATERIAL S AND METHODS 208 children with organoleptic test ( OLT ) scores of 2 or more were r and omly assigned to four groups : A : conventional oral hygiene practice s ( COH ) including toothbrushing and flossing ; B : COH + tongue scraping ( TS ) ; C : COH + TS + chlorhexidine ; D : COH + TS + chlorhexidine + probiotics . OLT was performed at 1-week and 3-month follow-ups . RESULTS A significant and stable number of participants showed major and moderate levels of improvement in OLT scores in group D ( p < 0.001 ) . The improvement of OLT scores in group C was also significant ( p < 0.001 ) , but not stable over the follow-ups ( p = 0.44 ) . Neither significant nor stable improvements in the OLT scores were detected in groups A and B through follow-ups ( p > 0.05 ) . CONCLUSION Probiotic therapy following oral disinfection with chlorhexidine may reduce the severity of halitosis over longer periods Orthodontic braces can impede oral hygiene and promote halitosis . The aim of the study was to investigate the effect of the oral probiotic Streptococcus salivarius M18 on oral hygiene indices and halitosis in patients wearing orthodontic braces . The study was a prospect i ve , r and omized , triple-blind , placebo-controlled trial . Patients undergoing fixed orthodontic treatment were r and omly allocated to a probiotic group  ( n = 32 ) and a placebo group ( n = 32 ) . Patients consumed 2 lozenges d-1 for one month . Assessment s were taken at baseline , at the end of the intervention , and at a 3 month follow-up . The outcome measures were plaque index ( PI ) , gingival index ( GI ) and halitosis-causing volatile sulfur compound ( VSC ) levels . The dental biofilms before and after the intervention were analyzed utilizing next-generation sequencing of bacterial 16S rRNA genes . PI and GI scores were not significantly influenced by the probiotic intervention ( intervention × time : p > 0.05 ) . The level of VSCs decreased significantly in both the probiotic group ( VSC reduction = -8.5 % , 95%CI = -7.4 % to -9.1 % , p = 0.015 ) and the placebo group ( -6.5 % , 95%CI = -6.0 % to -7.4 % , p = 0.039 ) after 1 month intervention . However , at the 3 month follow-up , the VSC levels in the placebo group returned to baseline levels whereas those in the probiotic group decreased further ( -10.8 % , 95%CI = -10.5 % to -12.9 % , p = 0.005 ) . Time , but not treatment , was associated with the decrease in microbial community alpha diversity and a modest effect on beta diversity . Oral probiotic S. salivarius M18 reduced the level of halitosis in patients with orthodontic braces , but had minimal effects on PI , GI and dental biofilm microflora Objective : Periodontitis is known to have multifactorial etiology , involving interplay between environmental , host and microbial factors . The current treatment approaches are aim ed at reducing the pathogenic microorganisms . Administration of beneficial bacteria ( probiotics ) has emerged as a promising concept in the prevention and treatment of periodontitis . Thus , the aim of the present study is to evaluate the efficacy of the local use of probiotics as an adjunct to scaling and root planing ( SRP ) in the treatment of patients with chronic periodontitis and halitosis . Methods : This is a r and omized , placebo-controlled , double-blinded trial involving 32 systemically healthy chronic periodontitis patients . After SRP , the subjects were r and omly assigned into the test and control groups . Test group ( SRP + probiotics ) received subgingival delivery of probiotics and probiotic mouthwash , and control group ( SRP + placebo ) received subgingival delivery of placebo and placebo mouthwash for 15 days . Plaque index ( PI ) , modified gingival index ( MGI ) , and bleeding index ( BI ) were assessed at baseline , 1 and 3 months thereafter , whereas probing depth ( PD ) and clinical attachment level were assessed at baseline and after 3 months . Microbial assessment using N-benzoyl-DL-arginine-naphthylamide ( BANA ) and halitosis assessment using organoleptic scores ( ORG ) was done at baseline , 1 and 3 months . Findings : All the clinical and microbiological parameters were significantly reduced in both groups at the end of the study . Inter-group comparison of PD reduction ( PDR ) and clinical attachment gain ( CAG ) revealed no statistical significance except for PDR in moderate pockets for the test group . Test group has shown statistically significant improvement in PI , MGI , and BI at 3 months compared to control group . Inter-group comparison revealed a significant reduction in BANA in test group at 1 month . ORG were significantly reduced in test group when compared to control group . Conclusion : Within the limitations of the study , the present investigation showed that the adjunctive use of probiotics offers clinical benefit in terms of pocket depth reduction in moderate pockets and reduced oral malodor parameters Background / Aims Despite numerous r and omized clinical trials and meta-analyses , there is no increased evidence for the efficacy of  probiotics  in the treatment of irritable bowel syndrome ( IBS ) . We review this evidence , identify and analyse the reasons for this lack of evidence and propose method ological improvements for future studies . Methods Based on a literature search , we identified 56 papers that matched the purpose of our analyses . Twenty-seven studies used multi-species bacterial preparations and 29 used single-strain probiotics . They were analysed regarding  patients included , treatment duration , probiotic dosage , and outcome measures . Results Trials in both groups suffered from heterogeneity with respect to probiotic concentration , duration of treatment , and other method ological issues ( crossover design and underpowered studies ) . This heterogeneity did not allow the application of a meta-analytic approach and a systematic review was therefore performed instead . Multi-strain preparations combined 2 to 8 different bacterial subspecies , mostly lactobacilli or bifidobacteria , and used variable lengths of treatments . Overall , more than 50 % of trials presented negative outcomes . The majority of the single-strain probiotic trials employing lactobacilli or Saccharomyces were negative , whereas trials employing bifidobacteria showed positive results . Conclusions The heterogeneity of the studies of probiotics in IBS questions the value of meta-analyses . The use of different bacterial strains and different mixtures of these strains , as well as different dosages , are the main contributors to this heterogeneity . Current data provides limited evidence for the efficacy of a small number of  single-strain probiotics  in IBS ( mostly bifidobacteria ) and sound studies following strict trial guidelines ( Food and Drug Administration and European Medicines Agency guidelines for clinical trials ) are needed . We summarised and proposed some method ological issues for future studies in the field Purpose of review This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect . Recent findings The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s ) of action of probiotics beyond simple barrier and antimicrobial effects . It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function . The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine . Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children , recurrent Clostridium difficile – induced infections and postoperative pouchitis . Level II evidence is emerging for the use of probiotics in other gastrointestinal infections , prevention of postoperative bacterial translocation , irritable bowel syndrome , and in both ulcerative colitis and Crohn disease . Nevertheless , one consistent feature has emerged over the past year : Not all probiotic bacteria have similar therapeutic effects . Future clinical trials will need to incorporate this fact into trial planning and design . Summary The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the “ mainstream . ” Mechanisms of action explain the therapeutic effects and r and omized ; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium OBJECTIVES To propose methods for mixed treatment comparisons ( MTC ) based on pooled summaries of the type produced in overviews of review s. STUDY DESIGN AND SETTING Overviews of review s ( umbrella review s ) summarize the results of multiple systematic review s into a single document . They report the summary estimates from the original pairwise meta-analyses and discuss them in narrative form , with the intention of identifying the most effective treatment . We present methods for MTC synthesis , tailored for use with overviews of review s. These generate a single internally consistent summary of all the relative treatment effects and assessment s of whether the summary is consistent with the data . These methods are applied to a published overview of treatments for childhood nocturnal enuresis . We apply the methods to both fixed-effect ( FE ) and r and om-effects ( RE ) meta-analyses of the original trials . RESULTS The summary relative risks based on FE meta-analyses , as originally published , were highly inconsistent . Those based on RE meta-analyses were consistent and could , given st and ard assumptions on comparability of treatment effects in meta- analysis , form a basis for coherent decision making . CONCLUSION Along with the summaries from systematic review s , MTC methods should be used in overviews to provide a single coherent analysis of all treatment comparisons and to check for evidence consistency There have been over twenty prospect i ve , r and omized trials of the use of probiotics to prevent  necrotizing enterocolitis ( NEC ) in premature babies . A Cochrane meta- analysis of 16 of the studies ( 1 ) including 2842 preterm infants , reported that ‘ enteral probiotics supplementation significantly reduced the incidence of severe NEC ( stage II or more ) ( typical RR , 0.35 ; 95 % CI , 0.24–0.52 ) and mortality ( typical RR , 0.40 ; 95 % CI , 0.27–0.60 ) with no evidence of harm . They concluded , ‘ Enteral supplementation of probiotics prevents severe NEC and all-cause mortality in preterm infants ’ . In a sensitivity analysis , including only the 4 highest quality studies , the results and conclusions were unchanged . For neonates born at < 32 weeks of gestation , the number needed to treat in order to prevent one NEC or one death is twenty . The risks of probiotics are minimal . A more recently published systematic review included several additional r and omized controlled trials , mostly published in the Chinese literature , and analysed a total of 20 publications and over 3800 preterm infants ; it came to similar conclusions as the Cochrane meta- analysis ( 2 ) . Probiotics are used in many European units but only rarely in North-America . In spite of the evidence , this safe and effective treatment for one of the most serious complications of prematurity has never been studied in the United States and perhaps never will . Probiotics will probably never be approved by the U.S. Food and Drug Administration ( FDA ) . Instead , they will remain in regulatory purgatory , neither approved nor unapproved , an evidence -based treatment that can not become the st and ard of care , a safe and effective treatment that is not on hospital formularies in the United States . Probiotics fall into a peculiar lacuna of the regulatory system . Most innovative treatments are either drugs or devices , and the regulatory pathways for evaluating and approving them are fairly well defined by federal law . The FDA has jurisdiction over both drugs and devices . Probiotics are neither drugs nor devices , and they are made by companies that generally market health products to the general public . In contrast , in Canada , probiotics are under the jurisdiction of the Natural Health Products Directorate ( NHPD ) which has rigorous requirements for quality control and detailed labelling . But the NHPD does not evaluate overtly medical cl aims made about a product . It has little experience dealing with either a product that could actually decrease major complications or save lives in a particularly fragile population where mortality is rather common . Probiotics are quite inexpensive to manufacture . People can even make them at home . They are in most yogurts . For pennies , some parents buy them for their preterm infants in health food stores . Some mothers have started adding probiotics to their breast milk . In these cases , the medical team can either be unaware a preterm infant is in fact receiving probiotics or tacitly not interfere with these parental initiatives . Given the low cost of probiotics and Articles in the series A Different View are edited by William Meadow ( wlm1@uchicago.edu ) . We encourage you to offer your own different view either in response to A Different View you do not fully agree with , or on an unrelated topic . Send your article to Dr. Meadow ( wlm1@uchicago.edu ) Many r and omized controlled trials ( RCTs ) have been done on role of probiotics as a treatment modality in allergic rhinitis . We conducted a review on the same . A systematic search of published literature was done . RCTs comparing effect of probiotics with placebo were included . A predefined set of outcome measures were assessed . Continuous data were expressed as pooled st and ardized mean difference ( SMD ) with 95 % confidence interval ( CI ) . Dichotomous data were expressed as odds ratio with 95 % CI . P value < 0.05 was considered significant . RevMan version 5 was used for all the analyses . Seven RCTs were eligible for inclusion .  Probiotic intake  improved quality of life score in patients with allergic rhinitis [ SMD -1.17 ( 95 % CI -1.47 , -0.86 ; P < 0.00001 ) ] . Other parameter that improved with probiotic intake was decrease in the number of episodes of rhinitis per year . There was no significant change in blood or immunologic parameters in the probiotic group , SMD -0.10 ( 95 % CI -0.26 , 0.06 ; P = 0.22 ) . Adverse events were not significant . Probiotic therapy might be useful in rhinitis , but the present data do not allow any treatment recommendations & NA ; Physical therapists seeking to use evidence to guide their practice may have limited time to read research reports . One way to reduce the time required to identify and read about the research that is relevant to a particular clinical question is to read a systematic review that summarizes multiple studies . This paper explains the process that is used to conduct systematic review s , which includes the establishment of a protocol , comprehensive search ing , appraisal of the quality of the included studies , data extraction and meta analysis , and consideration of the clinical and research implication s of the findings . We also consider how the reader of a systematic review can determine whether the review is likely to provide an unbiased ( believable ) estimate of the treatment effect . A systematic review of r and omized trials of a  cardiopulmonary physical therapy intervention is used as an example . The issue of appraisal of quality is then discussed further , with a demonstration of how one vali date d tool for quality appraisal ‐‐the PEDro scale‐‐can be used to evaluate a r and omized trial in cardiopulmonary physical therapy Gastrointestinal ( GI ) symptoms and irritable bowel ( IB ) symptoms have been associated with chronic fatigue syndrome/myalgic encephalomyelitis ( CFS/ME ) . The aim of this study was to conduct a systematic review of these symptoms in CFS/ME , along with any evidence for probiotics as treatment . Pubmed , Scopus , Medline ( EBSCOHost ) and EMBASE data bases were search ed to source relevant studies for CFS/ME . The review included any studies examining GI symptoms , irritable bowel syndrome ( IBS ) and /or probiotic use . Studies were required to report criteria for CFS/ME and study design , intervention and outcome measures . Quality assessment was also completed to summarise the level of evidence available . A total of 3381 publications were returned using our search terms . Twenty-five studies were included in the review . R and omised control trials were the predominant study type ( n = 24 ) . Most of the studies identified examined the effect of  probiotic supplementation on the improvement of IB symptoms in IBS patients , or IB symptoms in CFS/ME patients , as well as some other significant secondary outcomes ( e.g. quality of life , other gastrointestinal symptoms , psychological symptoms ) . The level of evidence identified for the use of  probiotics  in IBS was excellent in quality ; however , the evidence available for the use of probiotic interventions in CFS/ME was poor and limited . There is currently insufficient evidence for the use of probiotics in CFS/ME patients , despite probiotic interventions being useful in IBS . The studies pertaining to probiotic interventions in CFS/ME patients were limited and of poor quality overall . St and ardisation of protocol s and methodology in these studies is required Aims : With the increase in the number of systematic review s available , a logical next step to provide decision makers in healthcare with the evidence they require has been the conduct of review s of existing systematic review s. Syntheses of existing systematic review s are referred to by many different names , one of which is an umbrella review . An umbrella review allows the findings of review s relevant to a review question to be compared and contrasted . An umbrella review 's most characteristic feature is that this type of evidence synthesis only considers for inclusion the highest level of evidence , namely other systematic review s and meta-analyses . A methodology working group was formed by the Joanna Briggs Institute to develop method ological guidance for the conduct of an umbrella review , including diverse types of evidence , both quantitative and qualitative . The aim of this study is to describe the development and guidance for the conduct of an umbrella review . Methods : Discussion and testing of the elements of methods for the conduct of an umbrella review were held over a 6-month period by members of a methodology working group . The working group comprised six participants who corresponded via teleconference , e-mail and face-to-face meeting during this development period . In October 2013 , the methodology was presented in a workshop at the Joanna Briggs Institute Convention . Workshop participants , review authors and method ologists provided further testing , critique and feedback on the proposed methodology . Results : This study describes the methodology and methods developed for the conduct of an umbrella review that includes published systematic review s and meta-analyses as the analytical unit of the review . Details are provided regarding the essential elements of an umbrella review , including presentation of the review question in a Population , Intervention , Comparator , Outcome format , nuances of the inclusion criteria and search strategy . A critical appraisal tool with 10 questions to help assess risk of bias in systematic review s and meta-analyses was also developed and tested . Relevant details to extract from included review s and how to best present the findings of both quantitative and qualitative systematic review s in a reader friendly format are provided . Conclusions : Umbrella review s provide a ready means for decision makers in healthcare to gain a clear underst and ing of a broad topic area . The umbrella review methodology described here is the first to consider review s that report other than quantitative evidence derived from r and omized controlled trials . The methodology includes an easy to use and informative summary of evidence table to readily provide decision makers with the available , highest level of evidence relevant to the question posed Background Prevalence of  allergic diseases in infants , whose parents and siblings do not have allergy , is approximately 10 % and reaches 20–30 % in those with an allergic first-degree relative . Intestinal microbiota may modulate immunologic and inflammatory systemic responses and , thus , influence development of sensitization and allergy . Probiotics have been reported to modulate immune responses and their supplementation has been proposed as a preventive intervention . Objective The World Allergy Organization ( WAO ) convened a guideline panel to develop evidence -based recommendations about the use of probiotics in the prevention of allergy . Methods We identified the most relevant clinical questions and performed a systematic review of r and omized controlled trials of probiotics for the prevention of allergy . We followed the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach to develop recommendations . We search ed for and review ed the evidence about health effects , patient values and preferences , and re source use ( up to November 2014 ) . We followed the GRADE evidence -to-decision framework to develop recommendations . Results Currently available evidence does not indicate that probiotic supplementation  reduces the risk of developing allergy in children . However , considering all critical outcomes in this context , the WAO guideline panel determined that there is a likely net benefit from using probiotics result ing primarily from prevention of eczema . The WAO guideline panel suggests : a ) using probiotics in pregnant women at high risk for having an allergic child ; b ) using probiotics in women who breastfeed infants at high risk of developing allergy ; and c ) using probiotics in infants at high risk of developing allergy . All recommendations are conditional and supported by very low quality evidence . Conclusions WAO recommendations about probiotic supplementation for prevention of allergy are intended to support parents , clinicians and other health care professionals in their decisions whether to use probiotics in pregnancy and during breastfeeding , and whether to give them to infants BACKGROUND AND PURPOSE Acupuncture is widely used in the treatment of hypertension , yet its efficacy and safety for hypertension remain controversial . This overview aim ed to summarize the evidence on acupuncture for hypertension . METHODS Eight data bases were search ed . The Assessment of Multiple Systematic Review s ( AMSTAR ) tool and the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach were performed . RESULTS Fifteen systematic review s ( SRs ) were identified . Method ological quality and quality of evidence were unsatisfactory . Acupuncture combined with Western medicine ( WM ) was superior to WM in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) , efficacy rate , and traditional Chinese medicine ( TCM ) syndrome .  Acupuncture was more effective in treating SBP and DBP than sham acupuncture plus WM . Evidence regarding the benefit of acupuncture alone for SBP and DBP , efficacy rate and TCM syndrome was inconsistent . No serious adverse effects were identified . CONCLUSION High- quality SRs and r and omized controlled trials ( RCTs ) are required This systematic overview summarizes the relevant evidence from multiple systematic review s of the benefits of nonpharmacological interventions for preventing  type 2 diabetes mellitus ( T2MD ) in women diagnosed with gestational diabetes mellitus ( GDM ) . A comprehensive search using the Cochrane Library , CINAHL , EMBASE and MEDLINE via Ovid SP , and PubMed data bases was completed on 18 November 2015 . Any systematic review s that evaluated r and omized controlled trials ( RCTs ) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion . The authors independently performed critical appraisal s and quality assessment s of the included review s using the AMSTAR tool , and extracted data were converted to coherent values for tabular summarization . Six eligible review s of diet and /or exercise , breastfeeding , and reminder interventions were identified ; however , the method ologies of the review s varied greatly , and the majority of the evidence suggested unclear bias . We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression , but these interventions were found to be effective at reducing glycemic load . Combined diet , exercise , and breastfeeding interventions proved to be effective at returning women to their postpartum weight . Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM . Overall , there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM , and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM , such as glycemic load or anthropometric changes Background Depression is a common mental health disorder for which clinical practice guidelines have been developed . Prior systematic review s have identified complex organizational interventions , such as collaborative care , as effective for guideline implementation ; yet , many healthcare delivery organizations are interested in less re source -intensive methods to increase provider adherence to guidelines and guideline -concordant practice s. The objective of this systematic review was to assess the effectiveness of  healthcare provider  interventions that aim to increase adherence to evidence -based treatment of depression in routine clinical practice . Methods We search ed five data bases through August 2017 using a comprehensive search strategy to identify English- language r and omized controlled trials ( RCTs ) in the quality improvement , implementation science , and behavior change literature that evaluated outpatient provider interventions , in the absence of practice re design efforts , to increase adherence to treatment guidelines or guideline -concordant practice s for depression . We used meta- analysis to summarize odds ratios , st and ardized mean differences , and incidence rate ratios , and assessed quality of evidence ( QoE ) using the GRADE approach . Results Twenty-two RCTs promoting adherence to clinical practice guidelines or guideline -concordant practice s met inclusion criteria . Studies evaluated diverse provider interventions , including distributing guidelines to providers , education/training such as academic detailing , and combinations of education with other components such as targeting implementation barriers . Results were heterogeneous and analyses comparing provider interventions with usual clinical practice did not indicate a statistically significant difference in guideline adherence across studies . There was some evidence that provider interventions improved individual outcomes such as medication prescribing and indirect comparisons indicated more complex provider interventions may be associated with more favorable outcomes . We did not identify types of provider interventions that were consistently associated with improvements across indicators of adherence and across studies . Effects on patients ’ health in these RCTs were inconsistent across studies and outcomes . Conclusions Existing RCTs describe a range of provider interventions to increase adherence to depression guidelines . Low QoE and lack of replication of specific intervention strategies across studies limited conclusions that can be drawn from the existing research . Continued efforts are needed to identify successful strategies to maximize the impact of provider interventions on increasing adherence to evidence -based treatment for depression . Trial registration PROSPERO record CRD42017060460 on BACKGROUND : Eczema is the most common inflammatory skin disease of childhood , characterized by an itchy red rash that usually involves the face and skin folds . There is currently no curative treatment for eczema , so the reduction of eczema incidence through disease prevention is a desirable goal . Potential interventions for preventing eczema include exclusive breastfeeding , hydrolysed protein formulas and soy formulas when bottle feeding , maternal antigen avoidance , omega oil supplementation , prebiotics and probiotics . OBJECTIVES : This overview of review s aims to present the current body of data from Cochrane and non-Cochrane review s to provide the most up-to- date evidence on the efficacy and safety of interventions to prevent eczema in infants and children at different risk levels for developing allergic disease . METHODS : Our pool of Cochrane and non-Cochrane review s came from the 2010 United Kingdom National Health Service ( NHS ) Evidence Skin Disorders Annual Evidence Up date s Mapping Exercise on Atopic Eczema . This group used a comprehensive search strategy last conducted in August 2010 to identify all systematic review s on eczema prevention . We identified all review s that met our pre-specified inclusion criteria , and data were extracted , analysed , compiled into tables and synthesized using quantitative and qualitative methods . MAIN RESULTS : Seven systematic review s containing 39 relevant trials with 11 897 participants were included in this overview . Overall , there was no clear evidence that any of the main interventions review ed reduced eczema incidence . In subgroup analyses of infants at high risk of allergic disease , an observational study found that exclusive breastfeeding for at least six months compared with introduction of solids at three to six months decreased the incidence of eczema by 60 % ( risk ratio ( RR ) : 0.40 ; 95 % confidence interval ( CI ) : 0.21 , 0.78 ) , and a r and omized controlled trial found that prebiotics compared with no prebiotics  decreased incidence by 58 % ( RR : 0.42 ; 95 % CI : 0.21 , 0.84 ) . However , each of these findings was based on the results of a single small trial , and no intervention reduced eczema incidence beyond the first two years of life . Although we pre-specified incidence of atopic eczema ( i.e. eczema associated with immunoglobulin E ( IgE ) sensitization ) as a primary outcome , data on whether participants diagnosed with eczema were truly atopic were largely lacking from systematic review s. Similarly , data on atopy , measured using skin prick tests or specific IgE tests to allergens , were not reported in many review s. No interventions were found to decrease atopy when reported . Adverse events data were generally lacking , but data from a trial of probiotics versus no probiotics showed significantly more spitting up in the first one ( RR : 1.88 ; 95 % CI : 1.03 , 3.45 ) and two ( RR : 1.69 ; 95 % CI : 1.02 , 2.80 ) months of life , but no overall increase in risk of gastrointestinal symptoms in the first year . AUTHORS # ENTITYSTARTX02019 ; CONCLUSIONS : Although there is currently no clear evidence showing that any of the interventions examined in this overview prevent eczema in participants not selected for risk of allergic disease , there is some evidence that exclusive breastfeeding for at least six months and prebiotics might reduce eczema incidence in high-risk participants . However , these conclusions are based on limited evidence with method ological shortcomings . Future research on prevention of eczema is needed and should examine different types of hydrolysed formulas , prebiotics and probiotics , as well as enhancement of the skin barrier and other novel approaches in infants at different risk levels for developing allergic disease Systematic review s , a cornerstone of evidence -based medicine , are not produced quickly enough to support clinical practice . The cost of production , availability of the requisite expertise and timeliness are often quoted as major contributors for the delay . This detailed survey of the state of the art of information systems design ed to support or automate individual tasks in the systematic review , and in particular systematic review s of r and omized controlled clinical trials , reveals trends that see the convergence of several parallel research projects . We surveyed literature describing informatics systems that support or automate the processes of systematic review or each of the tasks of the systematic review . Several projects focus on automating , simplifying and /or streamlining specific tasks of the systematic review . Some tasks are already fully automated while others are still largely manual . In this review , we describe each task and the effect that its automation would have on the entire systematic review process , summarize the existing information system support for each task , and highlight where further research is needed for realizing automation for the task . Integration of the systems that automate systematic review tasks may lead to a revised systematic review workflow . We envisage the optimized workflow will lead to system in which each systematic review is described as a computer program that automatically retrieves relevant trials , appraises them , extracts and synthesizes data , evaluates the risk of bias , performs meta- analysis calculations , and produces a report in real time OBJECTIVE To evaluate the effects of fixed orthodontic treatment with steel-ligated conventional brackets and self-ligating brackets  on halitosis and periodontal health .  MATERIAL S AND METHODS Sixty patients , at the permanent dentition stage aged 12 to 18 years , who had Angle Class I malocclusion with mild-to-moderate crowding were r and omly selected . Inclusion criteria were nonsmokers , without systematic disease , and no use of antibiotics and oral mouth rinses during the 2-month period before the study . The patients were subdivided into three groups r and omly : the group treated with conventional brackets ( group 1 , n = 20 ) ligated with steel ligature wires , the group treated with self-ligating brackets ( group 2 , n = 20 ) , and the control group ( group 3 , n = 20 ) . The periodontal records were obtained 1 week before bonding ( T1 ) , immediately before bonding ( T2 ) , 1 week after bonding ( T3 ) , 4 weeks after bonding ( T4 ) , and 8 weeks after bonding ( T5 ) . Measurements of the control group were repeated within the same periods . The volatile sulfur components determining halitosis were measured with the Halimeter at T2 , T3 , T4 , and T5 . A two-way repeated measures of analysis of variance ( ANOVA ) was used to compare the groups statistically . RESULTS No statistically significant group × time interactions were found for plaque index , gingival index , pocket depth , bleeding on probing , and halitosis , which means three independent groups change like each other by time . The risk of tongue coating index ( TCI ) being 2 was 10.2 times higher at T1 than at T5 ( P < .001 ) . Therefore , the probability of higher TCI was decreased by time in all groups . CONCLUSIONS The self-ligating brackets do not have an advantage over conventional brackets with respect to periodontal status and halitosis Objective To summarize the evidence for curative and health enhancement effects through  forest therapy  and to assess the quality of studies based on a review of r and omized controlled trials ( RCTs ) . Study design A systematic review based on RCTs . Methods Studies were eligible if they were RCTs . Studies included one treatment group in which forest therapy was applied .  The following data bases – from 1990 to November 9 , 2010 – were search ed : MEDLINE via PubMed , CINAHL , Web of Science , and Ichushi- Web . All Cochrane data bases and Campbell Systematic Review s were also search ed up to November 9 , 2010 . Results Two trials met all inclusion criteria . No specific diseases were evaluated , and both studies reported significant effectiveness in one or more outcomes for health enhancement . However , the results of evaluations with the CONSORT ( Consoli date d St and ards of Reporting Trials ) 2010 and CLEAR NPT ( A Checklist to Evaluate a Report of a Nonpharmacological Trial ) checklists generally showed a remarkable lack of description in the studies . Furthermore , there was a problem of heterogeneity , thus a meta- analysis was unable to be performed . Conclusion Because there was insufficient evidence on forest therapy due to poor method ological and reporting quality and heterogeneity of RCTs , it was not possible to offer any conclusions about the effects of this intervention . However , it was possible to identify problems with current RCTs of forest therapy , and to propose a strategy for strengthening study quality and stressing the importance of study feasibility and original check items based on characteristics of forest therapy as a future research agenda Halitosis can exert a negative influence on the social relations of adolescents and affect one 's self-image . The aim of this study was to evaluate the clinical and microbiological effect of antimicrobial photodynamic therapy ( aPDT ) on  halitosis in adolescents . Forty-six individuals aged 12 to 19 years were r and omly allocated : Group 1 - treatment with photodynamic therapy ; Group 2 - treatment with a tongue scraper and Group 3 - treatment with a tongue scraper and photodynamic therapy . The count of bacterial colony-forming units per milliliter was used for the microbiological analysis . Statistical analysis involved the Kruskal-Wallis test followed by the Student-Newman-Keuls test . ANOVA was used for the determination of colony-forming units after treatment . The level of significance for all statistical tests was 5 % ( p < 0.05 ) . After treatment , a statistically significant reduction in total volatile sulfur compounds was found in all groups ( p < 0.001 ) , with the largest reduction ( median : 0 ) found in Group 3 ( tongue scraper and photodynamic therapy ) . Moreover , a statistically significant difference was found between treatment with aPDT and a tongue scraper alone ( p < 0.001 ) . The present findings demonstrate an option for the treatment of  halitosis in adolescents , with an immediate effect and without the mechanical aggression to the toungue . Clinical Trials : NCT02007993 Context : Rice bran oil , owing to its potential antioxidant benefits , could be an effective and novel alternative to sesame oil for oil pulling . As it is safe and a growingly popular edible oil , it may be acceptable during pregnancy , especially in the Indian context where women may be hesitant to use chemical plaque control methods for preventing halitosis . Aims : The present study was conducted to compare the effects of oil pulling with rice bran oil , oil pulling with sesame oil , and oil pulling with chlorhexidine mouth rinsing on reducing halitosis among pregnant women . Setting s and Design : Thirty pregnant women who attended the Gynecology Outpatient Department ( OPD ) of Muslim Medical Hospital , Haran Khana Road , Pani Gate , Vadodara , Gujarat , India , were recruited in the present r and omized double-blind interventional study . Subjects and Methods : Eligible pregnant women individuals who gave consent for the study were r and omly allocated to receive the interventions under investigation . Halitosis was measured at baseline and after 14 days of intervention using TANITA breath checker HC-212M-BL . Statistical Analysis Used : Data entry was done in Microsoft Excel 2007 , and statistical analysis was performed using SPSS version 17 . Wilcoxon signed rank tests were used to interpret the differences in baseline and postintervention halitosis levels . One-way ANOVA was done to compare the mean reduction in halitosis scores of the three intervention groups . Results : There was a statistically significant reduction in the grade s of halitosis at baseline and 14 days after intervention for all the three groups . There was no statistically significant difference between chlorhexidine mouth rinsing , oil pulling with sesame oil , and oil pulling with rice bran oil in halitosis reduction . Conclusions : Rice bran oil when used in oil pulling was effective in reducing halitosis . It performed comparably and marginally superior to other agents tested in the study when change in halitosis postintervention was considered QUESTION There has been a great deal of discussion in both the medical and lay literature about the use of probiotics to improve general health . Subsequently , pregnant women have been asking me if probiotics used for treating conditions such as bacterial vaginosis and diarrhea are safe to use during pregnancy and lactation . ANSWER Current data suggest that probiotic supplementation is rarely systemically absorbed when used by healthy individuals . One meta- analysis and several r and omized controlled trials conducted with women during the third trimester of pregnancy did not report an increase in adverse fetal outcomes . There have been no published studies addressing Saccharomyces species use in pregnancy . Probiotics are unlikely to be transferred into breast milk
Current evidence is supportive of recommending probiotics for the management of halitosis .
Based on this review , transient ( average of 2 weeks ) dosing with probiotics ( mainly Lactobacillus strains ) has a moderate effect on halitosis regarding OLT scores , but we could not confirm the effects of probiotics on the VSC reduction .
Although several studies have evaluated the inhibitory effect of  probiotics  on  halitosis  , findings are inconsistent .
This systematic review and meta- analysis of r and omized clinical trials ( RCT ) was conducted to summarize the evidence on the effect of  probiotics on halitosis .