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Zusammenfassung Hintergrund Die meisten Hepatitis-B-Virus-assoziierten Todesfälle bei Erwachsenen sind die Folge von Infektionen, die diese bereits bei ihrer Geburt oder in den ersten fünf Lebensjahren erworben haben. Ziel Die Erweiterung der Leitlinie zur Prävention der Mutter-zu-Kind-Übertragung des Hepatitis-B-Virus um antivirale Prophylaxe. Methode Die Leitlinie wurde von der Weltgesundheitsorganisation (WHO) gemäß WHO-Standards umgesetzt. Die Zusammenfassung wurde durch ein Team des WHO Collaborating Centre an der Donau-Universität Krems (Österreich) auf Deutsch übersetzt. Ergebnisse Neben der Empfehlung, schwangere Frauen auf das Hepatitis-B-Virus (HBV) zu testen und Neugeborene so bald wie möglich nach der Geburt gegen Hepatitis B zu impfen, wurden zwei neue Empfehlungen formuliert: Schwangere, die positiv auf eine HBV-Infektion getestet werden, sollen eine Tenofovir-Prophylaxe erhalten. Die WHO empfiehlt in Settings, wo keine vorgeburtliche HBV-DNA-Bestimmung verfügbar ist, das Testen auf HBeAg als Alternative. Damit soll die Eignung für eine Tenofovir-Prophylaxe beurteilt werden.

Utilisation of crowdsourcing within evidence synthesis has increased over the last decade. Crowdsourcing platform Cochrane Crowd has engaged a global community of 22,000 people from 170 countries. The COVID-19 pandemic presented an opportunity to engage the community and keep up with the exponential output of COVID-19 research.To test whether a crowd could accurately assess study eligibility for reviews under time constraints.time taken to complete each task, time to produce required training modules, crowd sensitivity, specificity and crowd consensus.We created four crowd tasks, corresponding to four Cochrane COVID-19 Rapid Reviews. The search results of each were uploaded and an interactive training module was developed for each task. Contributors who had participated in another COVID-19 task were invited to participate. Each task was live for 48-h. The final inclusion and exclusion decisions made by the core author team were used as the reference standard.Across all four reviews 14,299 records were screened by 101 crowd contributors. The crowd completed each screening task within 48-h for three reviews and in 52 h for one. Sensitivity ranged from 94% to 100%. Four studies, out of a total of 109, were incorrectly rejected by the crowd. However, their absence ultimately would not have altered the conclusions of the reviews. Crowd consensus ranged from 71% to 92% across the four reviews.Crowdsourcing can play a valuable role in study identification and offers willing contributors the opportunity to help identify COVID-19 research for rapid evidence syntheses.

Objectives To assess the impact of restricting systematic reviews of conventional or alternative medical treatments or diagnostic tests to English-language publications. Study design and setting We systematically searched MEDLINE (Ovid), the Science Citation Index Expanded (Web of Science), and Current Contents Connect (Web of Science) up to April 24, 2020. Eligible methods studies assessed the impact of restricting systematic reviews to English-language publications on effect estimates and conclusions. Two reviewers independently screened the literature; one investigator performed the data extraction, a second investigator checked for completeness and accuracy. We synthesized the findings narratively. Results Eight methods studies (10 publications) met the inclusion criteria; none addressed language restrictions in diagnostic test accuracy reviews. The included studies analyzed nine to 147 meta-analyses and/or systematic reviews. The proportions of non-English-language publications ranged from 2% to 100%. Based on five methods studies, restricting literature searches or inclusion criteria to English-language publications led to a change in statistical significance in 23/259 meta-analyses (9%). Most commonly, the statistical significance was lost, but had no impact on the conclusions of systematic reviews. Conclusion Restricting systematic reviews to English-language publications appears to have little impact on the effect estimates and conclusions of systematic reviews.

Most HBV-associated deaths among adults are secondary to infections acquired at birth or in the first five years of life.To extend the guideline for the prevention of mother-to-child transmission of the hepatitis B virus to include antiviral prophylaxis.The guideline was developed by the World Health Organization (WHO) in accordance with WHO standards. The summary was translated into German by employees of the WHO Collaborating Centre at Danube University Krems (Austria).In addition to the recommendation to test pregnant women for heptatitis B virus (HBV) and vaccinate newborns against hepatitis B as soon as possible after birth, two new recommendations have been formulated: pregnant women testing positive for HBV infection should receive tenofovir prophylaxis to prevent mother-to-child transmission of HBV. WHO recommends that in settings in which antenatal HBV DNA testing is not available, HBeAg testing can be used as an alternative to determine eligibility for tenofovir prophylaxis.Die meisten Hepatitis-B-Virus-assoziierten Todesfälle bei Erwachsenen sind die Folge von Infektionen, die diese bereits bei ihrer Geburt oder in den ersten fünf Lebensjahren erworben haben. ZIEL: Die Erweiterung der Leitlinie zur Prävention der Mutter-zu-Kind-Übertragung des Hepatitis-B-Virus um antivirale Prophylaxe.Die Leitlinie wurde von der Weltgesundheitsorganisation (WHO) gemäß WHO-Standards umgesetzt. Die Zusammenfassung wurde durch ein Team des WHO Collaborating Centre an der Donau-Universität Krems (Österreich) auf Deutsch übersetzt.Neben der Empfehlung, schwangere Frauen auf das Hepatitis-B-Virus (HBV) zu testen und Neugeborene so bald wie möglich nach der Geburt gegen Hepatitis B zu impfen, wurden zwei neue Empfehlungen formuliert: Schwangere, die positiv auf eine HBV-Infektion getestet werden, sollen eine Tenofovir-Prophylaxe erhalten. Die WHO empfiehlt in Settings, wo keine vorgeburtliche HBV-DNA-Bestimmung verfügbar ist, das Testen auf HBeAg als Alternative. Damit soll die Eignung für eine Tenofovir-Prophylaxe beurteilt werden.

This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group. Rapid reviews (RRs) use modified systematic review methods to accelerate the review process while maintaining systematic, transparent and reproducible methods. This paper addresses considerations for rating the certainty of evidence (COE) in RRs. We recommend the full implementation of GRADE (Grading of Recommendations, Assessment, Development and Evaluation) for Cochrane RRs if time and resources allow.If time or other resources do not permit the full implementation of GRADE, the following recommendations can be considered: (1) limit rating COE to the main intervention and comparator and limit the number of outcomes to critical benefits and harms; (2) if a literature review or a Delphi approach to rate the importance of outcomes is not feasible, rely on informal judgements of knowledge users, topic experts or team members; (3) replace independent rating of the COE by two reviewers with single-reviewer rating and verification by a second reviewer and (4) if effect estimates of a well-conducted systematic review are incorporated into an RR, use existing COE grades from such a review. We advise against changing the definition of COE or the domains considered part of the GRADE approach for RRs.

This paper is part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group (RRMG). Rapid reviews (RRs) use modified systematic review (SR) methods to accelerate the review process while maintaining systematic, transparent and reproducible methods to ensure integrity. This paper addresses considerations around the acceleration of study selection, data extraction and risk of bias (RoB) assessment in RRs. If a RR is being undertaken, review teams should consider using one or more of the following methodological shortcuts: screen a proportion (eg, 20%) of records dually at the title/abstract level until sufficient reviewer agreement is achieved, then proceed with single-reviewer screening; use the same approach for full-text screening; conduct single-data extraction only on the most relevant data points and conduct single-RoB assessment on the most important outcomes, with a second person verifying the data extraction and RoB assessment for completeness and correctness. Where available, extract data and RoB assessments from an existing SR that meets the eligibility criteria.

Zusammenfassung Ziel Im Zuge der COVID-19-Pandemie benötigen viele gesundheitsrelevante Fragestellungen rasche Antworten. Im Kompetenznetz Public Health zu COVID-19, das im März 2020 von Vertreter:innen mehrerer wissenschaftlicher Fachgesellschaften gegründet wurde, werden vielfach Rapid Reviews erstellt, um rasch evidenzbasierte, für politische Entscheidungsträger:innen nutzbare Antworten zu generieren. Ziel dieses Beitrags ist es, die praktischen Erfahrungen bei der Durchführung von Rapid Reviews im Rahmen des Kompetenznetzes Public Health zu reflektieren. Auf dieser Grundlage sollen Methoden zur qualitativ hochwertigen und praktikablen Durchführung von Rapid Reviews entwickelt werden, die insbesondere auch zur raschen Evidenzgenerierung auf der Grundlage von Beobachtungsstudien anwendbar sind. Methodik Unter Nutzung des von Tricco et al. [1] vorgeschlagenen 8-schrittigen Vorgehens werden die aktuellen Herausforderungen beschrieben, die sich im Kompetenznetz Public Health zu COVID-19 bei der Durchführung von Rapid Reviews zu Public Health-bezogenen Fragen der COVID-19-Pandemie ergeben haben. Die 8 Schritte lauten: 1. Formulierung der Fragestellung, 2. Literatursuche, 3. Titel-Abstract- und Volltextsichtung, 4. Datenextraktion, 5. Risk of Bias-Bewertung, 6. Evidenzsynthese, 7. Dissemination, 8. Aktualisierung. Zudem werden Lösungsvorschläge im Expert:innenkonsens der Mitglieder (n=42 zum 28.01.2021) der Querschnitts-AG Rapid Reviews des Kompetenznetzes Public Health zu COVID-19 entwickelt. Ergebnisse Vorgelegt und zur Diskussion gestellt wird ein standardisiertes Vorgehen, das sich eng an das Vorgehen der Cochrane Rapid Reviews Methods Group anlehnt und den besonderen Anforderungen von ätiologisch orientierten, häufig auch ökologischen Beobachtungsstudien zu COVID-19 Rechnung trägt. Schlussfolgerungen Das vorgeschlagene Vorgehen bei der Durchführung von Rapid Reviews kann – ggf. über Fragestellungen zu COVID-19 hinaus – eine wichtige Grundlage einer evidenzbasierten Politikberatung bilden. Zur kurzfristigen Realisierung von methodisch hochwertigen Rapid Reviews zu neuen Fragestellungen sollten flexible und kurzfristig aktivierbare Förderkonzepte bereitgestellt werden. Wissenschaftliche Kooperationen bei der Durchführung von Rapid Reviews sollten ausgebaut werden, dabei sollten verstärkt methodisch hochwertige Ansätze wie bspw. prospektive Metaanalysen Anwendung finden.

Background: Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become more urgent with the spread of more infectious SARS-CoV-2 variants of concern (VoC), and the potential psychological toll imposed by the coronavirus disease 2019 (COVID-19) pandemic. Controlling exposures to occupational hazards is the fundamental method of protecting workers. When it comes to the transmission of viruses, such as SARS-CoV-2, workplaces should first consider control measures that can potentially have the most significant impact. According to the hierarchy of controls, one should first consider elimination (and substitution), then engineering controls, administrative controls, and lastly, personal protective equipment (PPE). Objectives: To assess the benefits and harms of interventions in non-healthcare-related workplaces to reduce the risk of SARS-CoV-2 infection relative to other interventions, or no intervention. Search methods: We searched MEDLINE, Embase, Web of Science, Cochrane COVID-19 Study Register, the Canadian Centre for Occupational Health and Safety (CCOHS), Clinicaltrials.gov, and the International Clinical Trials Registry Platform to 14 September 2021. We will conduct an update of this review in six months. Selection criteria: We included randomised control trials (RCT) and planned to include non-randomised studies of interventions. We included adult workers, both those who come into close contact with clients or customers (e.g. public-facing employees, such as cashiers or taxi drivers), and those who do not, but who could be infected by co-workers. We excluded studies involving healthcare workers. We included any intervention to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace, defining categories of intervention according to the hierarchy of hazard controls, i.e. elimination; engineering controls; administrative controls; personal protective equipment. Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were incidence rate of SARS-CoV-2 infection (or other respiratory viruses), SARS-CoV-2-related mortality, adverse events, and absenteeism from work. Our secondary outcomes were all-cause mortality, quality of life, hospitalisation, and uptake, acceptability, or adherence to strategies. We used the Cochrane RoB 2 tool to assess the risk of bias, and GRADE methods to assess the certainty of evidence for each outcome. Main results: Elimination of exposure interventions. We included one study examining an intervention that focused on elimination of hazards. This study is an open-label, cluster-randomised, non-inferiority trial, conducted in England in 2021. The study compared standard 10-day self-isolation after contact with an infected person to a new strategy of daily rapid antigen testing and staying at work if the test is negative (test-based attendance). The trialists hypothesised that this would lead to a similar rate of infections, but lower COVID-related absence. Staff (N = 11,798) working at 76 schools were assigned to standard isolation, and staff (N = 12,229) at 86 schools to the test-based attendance strategy. The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of symptomatic PCR-positive SARS-COV-2 infection rate ratio ((RR) 1.28, 95% confidence interval (CI) 0.74 to 2.21; 1 study, very low-certainty evidence)). The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of any PCR-positive SARS-COV-2 infection (RR 1.35, 95% CI 0.82 to 2.21; 1 study, very low-certainty evidence). COVID-related absenteeism rates were 3704 absence days in 566,502 days-at-risk (6.5 per 1000 days at risk) in the control group and 2932 per 539,805 days-at-risk (5.4 per 1000 days at risk) in the intervention group (RR 0.83; 95% CI 0.55 to 1.25). The certainty of the evidence was downgraded to low, due to imprecision. Uptake of the intervention was 71 % in the intervention group, but not reported for the control intervention. The trial did not measure other outcomes, SARS-CoV-2-related mortality, adverse events, all-cause mortality, quality of life, and hospitalisation. We found one ongoing RCT about screening in schools, using elimination of hazard strategies. Personal protective equipment. We found one ongoing non-randomised study on the effects of closed face shields to prevent COVID-19 transmission. Other intervention categories. We did not find studies in the other intervention categories. Authors' conclusions: We are uncertain whether a test-based attendance policy affects rates of PCR-postive SARS-CoV-2 infection (any infection; symptomatic infection) compared to standard 10-day self-isolation amongst school and college staff. Test-based attendance policy may result in little to no difference in absence rates compared to standard 10-day self-isolation. As a large part of the population is exposed in the case of a pandemic, an apparently small relative effect that would not be worthwhile from the individual perspective may still affect many people, and thus, become an important absolute effect from the enterprise or societal perspective. The included study did not report on any other primary outcomes of our review, i.e. SARS-CoV-2-related mortality and adverse events. No completed studies were identified on any other interventions specified in this review, but two eligible studies are ongoing. More controlled studies are needed on testing and isolation strategies, and working from home, as these have important implications for work organisations.

Zusammenfassung Ziel Ziel dieses Artikels ist es, eine detaillierte Anleitung zu geben, wie Gerechtigkeit im Gesundheitswesen bei der Erstellung von Empfehlungen nach GRADE (Grading of Recommendations, Assessment, Development and Evaluation) einbezogen werden kann. Studiendesign und Setting Wir haben diese Anleitung basierend auf dem GRADE-Ansatz „von der Evidenz zur Empfehlung“ entwickelt. Die Anleitung entstand in einem iterativen Prozess, Entwurfe wurden personlich mit Projektgruppenmitgliedern besprochen und die Beitrage anderer Mitglieder der GRADE Arbeitsgruppe wurden berucksichtigt. Die vorliegende Arbeit ist eine deutsche Ubersetzung der englischsprachigen Originalpublikation. Ergebnisse Sowohl generelle Leitlinien als auch Leitlinien, die sich auf benachteiligte Bevolkerungsgruppen konzentrieren, sollten Uberlegungen dahingehend anstellen, welchen Einfluss die Empfehlungen auf Gerechtigkeit im Gesundheitswesen haben konnen. Wir schlagen zwei Ansatze vor, um Gerechtigkeitsuberlegungen einzubeziehen: (1) Bewertung der potenziellen Auswirkungen von Interventionen auf die Gerechtigkeit und (2) Einbeziehung von Gerechtigkeitsuberlegungen bei der Beurteilung oder Abwagung der einzelnen Kriterien im „Evidence-to-decision (EtD)-Prozess“. Wir stellen eine Anleitung und illustrierende Beispiele bereit. Schlussfolgerung Leitliniengremien sollten die Auswirkungen der Empfehlungen auf die Gerechtigkeit im Gesundheitswesen unter Berucksichtigung von abgelegenen und unterversorgten Settings und benachteiligten Bevolkerungsgruppen prufen. Leitliniengremien konnen die Einschatzung zur Gerechtigkeit auch im Rahmen des EtD-Prozesses berucksichtigen. Dies ist der vierte und letzte Artikel in einer Serie uber die Berucksichtigung von Gerechtigkeit im Gesundheitswesen im Entwicklungsprozess von GRADE-Leitlinien. Diese Serie stammt aus der GRADE-Gruppe zu Gerechtigkeit im Gesundheitswesen.

Zusammenfassung Hintergrund Trotz beachtlicher Fortschritte im Kampf gegen Tuberkulose, stellt diese nach wie vor die am häufigsten zum Tode führende bakterielle Infektionskrankheit weltweit dar. Jedes Jahr versterben weltweit nach wie vor bis zu 10 Mio. Menschen an Tuberkulose. Die World Health Assembly hat es sich zum Ziel gesetzt die Zahl der Tuberkulose-Toten bis zum Jahr 2030 um 90% zu senken, die Zahl der Neuansteckungen um 80%. Hierbei sollte besonderes auf Maßnahmen zur Prävention und Infektionskontrolle in öffentlichen Gesundheitseinrichtungen und überall dort, wo das Übertragungsrisiko für das Tuberkulose-Bakterium „Mycobacterium tuberculosis“ hoch ist, gesetzt werden. Zielsetzung Ziel ist es aktualisierte und evidenzbasierte Empfehlungen für Public Health Maßnahmen zu geben, um die Ausbreitung des Tuberkulose-Bakteriums im klinischen Setting und im Tuberkulose-Management vorzubeugen. Methodik Die Leitlinie wurde von der Weltgesundheitsorganisation (WHO) gemäß der im WHO Handbuch zur Leitlinienentwicklung empfohlene Methode umgesetzt. Die vorliegende Publikation fasst die wichtigsten Punkte der Leitlinie zusammen und wurde von Mitarbeiterinnen und Mitarbeitern des WHO Collaborating Centre an der Donau-Universität Krems (Österreich) auf Deutsch übersetzt. Ergebnisse Diese Leitlinie berücksichtigt die aktuelle Studienlage und gibt Empfehlungen und Anmerkungen zur Umsetzung von Tuberkuloseprävention- und kontrolle auf Ebene von Gesundheitseinrichtungen sowie auf nationaler Ebene.

Zusammenfassung Ziel Ziel dieses Artikels ist es, einen konzeptionellen Rahmen fur die Berucksichtigung der Gerechtigkeit im Gesundheitswesen bei der Entwicklung von GRADE-Leitlinien zu beschreiben. Studiendesign und Setting Konsensorientierte Anleitung wurde von den Mitgliedern der GRADE-Arbeitsgruppe und anderen Methodikerinnen und Methodikern entwickelt. Die vorliegende Arbeit ist eine deutsche Ubersetzung der englischsprachigen Originalpublikation. Ergebnisse Wir haben eine konsensorientierte Anleitung entwickelt, die helfen sollen, die Gerechtigkeit im Gesundheitswesen bei der Einschatzung der Vertrauenswurdigkeit der synthetisierten Evidenz (bzw. Qualitat der Evidenz) zu berucksichtigen. Wenn festgestellt wird, dass gesundheitliche Ungerechtigkeit ein Anliegen der Interessengruppen ist, schlagen wir funf Methoden zur expliziten Bewertung der Gerechtigkeit im Gesundheitswesen vor: (1) die Gerechtigkeit im Gesundheitswesen als Endpunkt einbeziehen; (2) patientenrelevante Endpunkte, die fur die Gerechtigkeit im Gesundheitswesen relevant sind, berucksichtigen; (3) Unterschiede in der relativen Effektgrose der Behandlung bewerten; (4) Unterschiede im Basisrisiko und die unterschiedlichen Auswirkungen auf die absoluten Effekte bewerten; und (5) die Ubertragbarkeit von Evidenz fur benachteiligte Bevolkerungsgruppen und/oder Settings zu bewerten. Fazit Die wichtigste Prioritat fur die Forschung uber gesundheitliche Ungerechtigkeit und Leitlinien besteht darin, Beispiele zu identifizieren und zu dokumentieren, bei denen die Gerechtigkeit im Gesundheitswesen in den Leitlinien explizit berucksichtigt wurde. Auch wenn es eine schwache wissenschaftliche Evidenzgrundlage fur die Bewertung der gesundheitlichen Chancengleichheit gibt, sollte dies nicht davon abhalten, ausdrucklich zu prufen, wie sich Leitlinien und Empfehlungen auf die am starksten gefahrdeten Mitglieder der Gesellschaft auswirken.

COVID-19 (coronavirus disease 2019) is a new, rapidly emerging zoonotic infectious disease, that was reported to the World Health Organization for the first time on 31 December 2019. Currently, no effective pharmacological interventions or vaccines are available to treat or prevent COVID-19, therefore nonpharmacological public health measures are more in focus.The aim was to assess the effects of quarantine - alone or in combination with other measures - during coronavirus outbreaks.Because of the current COVID-19 pandemic, WHO commissioned a rapid review. To save time, the method of systematic reviews was slightly and with caution modified. This publication is a summary of the most important aspects of the rapid review, translated into German by members of the WHO Collaborating Centre at the Danube University Krems (Austria).Overall, 29 studies were included. Ten modeling studies focused on COVID-19, 4 observational studies and 15 modeling studies focused on SARS and MERS. The modeling studies consistently reported a benefit of the simulated quarantine measures. For example, the models estimated that quarantine of people exposed to confirmed or suspected cases of COVID-19 prevented between 44 and 81% of the cases that would otherwise have happened and 31 to 63% of the deaths, when compared to no such measures. In regard to costs, the earlier the quarantine measures are implemented, the greater the cost savings will be.Our confidence in the evidence is very limited. This is mainly because the COVID-19 studies based their models on the limited data that have been available in the early weeks of the pandemic and made different assumptions about the virus. The studies of SARS and MERS are not completely generalizable to COVID-19. Despite only having limited evidence, all the studies found quarantine to be important for controlling the spread of severe coronavirus diseases. Looking to the coming months, in order to maintain the best possible balance of measures, decision makers must continue to constantly monitor the outbreak situation and the impact of the measures they implement.Die Coronavirus-Krankheit COVID-19 ist eine neue, sich rasch ausbreitende zoonotische Infektionskrankheit, die der Weltgesundheitsorganisation (WHO) erstmals am 31. Dezember 2019 gemeldet wurde. Da zurzeit keine wirksamen Medikamente oder Impfstoffe zur Behandlung oder Prävention von COVID-19 zur Verfügung stehen, rücken nicht-pharmakologische Public-Health-Maßnahmen zur Eindämmung der COVID-19 Pandemie stärker in den Fokus.Ziel dieses Rapid Reviews war es, den Effekt von Quarantäne – alleine oder in Kombination mit weiteren Public-Health-Maßnahmen – zur Eindämmung von COVID-19 zu untersuchen.Der vorliegende Rapid Review wurde von der WHO in Auftrag gegeben. Um der Dringlichkeit der Anfrage gerecht zu werden, wurde die Methodik eines systematischen Reviews punktuell abgeändert. Die vorliegende Publikation umfasst die wichtigsten Aspekte des Rapid Reviews und wurde vom WHO Collaborating Centre an der Donau Universität Krems (Österreich) auf Deutsch übersetzt.Insgesamt wurden 29 Studien eingeschlossen. Zehn Modellierungsstudien befassten sich direkt mit COVID-19, 15 weitere Modellierungsstudien und 4 Beobachtungsstudien lieferten indirekte Evidenz zu SARS und MERS. Die Studien zeichneten alle ein ähnliches Bild – einen Vorteil von Quarantäne. Beispielsweise schätzten Modellierungsstudien, dass durch Quarantäne von Personen, die Kontakt mit Infizierten hatten 44–81% neuer Fälle und 31–63% an Todesfällen verhindert werden können, im Vergleich zu keinen Maßnahmen. Zwei Studien zu SARS zeigten, dass Quarantäne effektiver war und weniger kostete, je früher sie startete. Alleinige Quarantäne von Personen, die Kontakt mit Infizierten hatten, würde aber wahrscheinlich nicht ausreichen, um den Ausbruch von COVID-19 einzudämmen. Die Kombination mit anderen Maßnahmen wie physische Distanzierung oder Schulschließungen zeigte größere Effekte als Quarantäne alleine. Bei der individuellen Quarantäne für Rückkehrende aus Risikogebieten fand der Review vergleichsweise geringe Effekte.Die Vertrauenswürdigkeit der Evidenz ist niedrig bzw. sehr niedrig, da die einzigen Studien zu COVID-19 Modellierungsstudien sind, die zwar aktuelle aber noch unsichere und unterschiedliche Parameter zur Modellberechnung verwendeten. Die indirekte Evidenz von SARS und MERS ist nur begrenzt auf COVID-19 übertragbar. Trotz dieser Limitationen, kommen alle Studien zu dem Schluss, dass Quarantäne eine wichtige Maßnahme ist, um die Pandemie einzudämmen. Im Hinblick auf die kommenden Monate ist es wichtig, das Infektionsgeschehen sowie die Auswirkungen der Maßnahmen genau zu überwachen, um die bestmögliche Balance der Maßnahmen zu finden.

Zusammenfassung Ziel Bereitstellen einer Handlungsempfehlung zur Einschatzung des Risikos fur Bias von nicht-randomisierten Interventionsstudien mittels ROBINS-I (Risk Of Bias In Nonrandomized Studies of Interventions) im Rahmen der Bewertung der Vertrauenswurdigkeit der Evidenz mit GRADE. Der Artikel richtet sich an Autorinnen und Autoren systematischer Reviews, Entwicklerinnen und Entwickler von Leitlinien sowie Beschaftigte im Bereich Health Technology Assessment (HTA). Studiendesign und Setting Es wurden iterative Diskussionen, Testungen im Rahmen von systematischen Reviews sowie Prasentationen im Rahmen von GRADE-Arbeitsgruppentreffen mit Feedback durch die Mitglieder der GRADE-Arbeitsgruppe eingesetzt. Ergebnisse Es wird beschrieben, auf welcher Stufe die Bewertung eines Evidenzkorpers bei der Anwendung von ROBINS-I beginnt und welche finale Bewertung der Vertrauenswurdigkeit der Evidenz vermutlich daraus resultieren wird. GRADE berucksichtigt Aspekte, die die Bedenken bezuglich Confounding und Selektionsbias abschwachen, indem Domanen zum Heraufstufen eingefuhrt wurden: Grose Effeke, Dosis-Wirkungsbeziehung und die Erhohung der Vertrauenswurdigkeit durch plausible residuale Confounder oder andere Verzerrungen. Diese Domanen mussen bei der Bewertung eines Evidenzkorpers berucksichtigt werden, wenn ROBINS-I verwendet wird. Schlussfolgerung Die Anwendung von ROBINS-I im Rahmen von GRADE kann eine bessere Vergleichbarkeit von Evidenz aus randomisierten kontrollierten Studien (RCTs) und nicht-randomisierten Studien (NRSs) ermoglichen, da ein gemeinsamer Referenzstandard fur die Bewertung des Risikos fur Bias verwendet wird. Herausfordernd bleibt weiterhin unter anderem, wie Evidenz aus RCTs und NRSs zur Entscheidungsfindung angemessen dargestellt werden kann und wie RCTs und NRSs innerhalb einer Evidenzbewertung optimal integriert werden konnen.

Objectives: We aimed to assess whether limiting the inclusion criteria solely to English-language publications affected the overall conclusions of evidence syntheses.Study Design and Setting: Our analyses used a dataset of a previous methods study that included 59 randomly selected Cochrane intervention reviews with no language restrictions. First, we ascertained the publication language of all 2,026 included publications. Next, we excluded studies based on the following criteria: (1) publication solely in non-English language, or (2) main publication (in case of multiple publications of the same study) in non-English language. We then re-calculated meta-analyses for outcomes that were presented in the main summary of findings tables of the Cochrane reports. If the direction of the effect estimate or the statistical significance changed, authors of the respective Cochrane reviews were consulted to assess whether the new evidence base would have changed their conclusions. The primary outcome of our analyses examined the proportion of conclusions that would change with the exclusion of non-English publications. We set the threshold for the approach as noninferior if the upper limit of the 95% confidence interval of the proportion of changed conclusions did not cross a margin of 10%.Results: Across all 59 Cochrane reviews, 29 (49%) included 80 non-English publications. For 16 (27%) of these Cochrane reviews, the exclusion of non-English publications resulted in the exclusion of at least one study. In the remaining 13 Cochrane reviews, the non-English publications were not the only or main publication of the study or they did not contribute to the main summary of the findings table, so their exclusion did not result in an exclusion of the study.Overall, the exclusion of non-English publications led to the exclusion of 31 studies contributing to 40 outcomes. For 38 of the 40 outcomes, the exclusion of non-English studies did not markedly alter the size or direction of effect estimates or statistical significance. In two outcomes, the statistical significance changed, but authors would have still drawn the same conclusion, albeit with less certainty. Thus, the proportion of changed conclusions in our sample was 0.0% (95% CI 0.0-0.6), which indicated the noninferiority of the approach. However, the majority of excluded studies were small.Conclusion: Exclusion of non-English publications from systematic reviews on clinical interventions had a minimal effect on overall conclusions and could be a viable methodological shortcut, especially for rapid reviews. (C) 2019 Elsevier Inc. All rights reserved.

BACKGROUND AND OBJECTIVES: Assessing changes in coverage, recall, review, conclusions and references not found when searching fewer databases. METHODS: In randomly selected 60 Cochrane reviews, we checked included study publications' coverage (indexation) and recall (findability) using different search approaches with MEDLINE, Embase, and CENTRAL and related them to authors' conclusions and certainty. We assessed characteristics of unfound references. RESULTS: Overall 1989/2080 included references, were indexed in ≥1 database (coverage = 96%). In reviews where using one of our search approaches would not change conclusions and certainty (n = 44-54), median coverage and recall were highest (range 87.9%-100.0% and 78.2%-93.3%, respectively). Here, searching ≥2 databases reached >95% coverage and ≥87.9% recall. In reviews with unchanged conclusions but less certainty (n = 2-8): 63.3%-79.3% coverage and 45.0%-75.0% recall. In reviews with opposite conclusions (n = 1-3): 63.3%-96.6% and 52.1%-78.7%. In reviews where a conclusion was no longer possible (n = 3-7): 60.6%-86.0% and 20.0%-53.8%. The 265 references that were indexed but unfound were more often abstractless (30% vs. 11%) and older (28% vs. 17% published before 1991) than found references. CONCLUSION: Searching ≥2 databases improves coverage and recall and decreases the risk of missing eligible studies. If researchers suspect that relevant articles are difficult to find, supplementary search methods should be used.

Objective To summarize the evidence on the effectiveness of soil remediation to prevent or reduce lead exposure. Methods We systematically searched MEDLINE, the Agricultural & Environmental Science Database, Web of Science, and Scopus from 1980 to February 15, 2021. We also performed reference list checking, hand-searched websites, and contacted experts. Eligible studies evaluated the effect of soil remediation to prevent or reduce lead exposure in humans of any age. We screened all records dually; one investigator performed the data extraction; a second checked for completeness and accuracy. Two investigators independently rated the risk of bias of included studies and graded the certainty of evidence. We synthesized findings narratively. Results We identified 6614 potentially relevant publications, all focused on children, of which five studies (six records) fulfilled our prespecified inclusion criteria. The number of evaluated participants ranged from 31 to 1425, with follow-up periods of 11 months to one year. The primary soil remediation method was the replacement of the upper layer with clean soil. Outcomes were limited to blood lead levels (BLL), dust lead levels, and soil lead levels. The largest study, a controlled before– after study (n = 1425) reported favorable effects of soil remediation compared to no intervention. This finding was consistent with results from two cross-sectional studies and one uncontrolled before–after study. One year post-remediation, the mean reduction in BLL was 2.1 μg/dL (p, Graphical abstract Unlabelled Image, Highlights • Lead exposure from contaminated soil is an important public health issue, concerning both children and adults. • Soil remediation alone or in combination with other interventions appears to reduce the blood lead levels in children. • The effect of soil remediation on health outcomes, in high lead exposure areas or in low/middle-income countries is unclear.

Zusammenfassung Hintergrund Stillen ist eine wichtige Grundlage für die Gesundheit und Entwicklung eines Kindes, in manchen Teilen der Welt auch für das Überleben eines Kindes. Trotz umfangreicher Belege dafür, dass Nicht-Stillen global mit erhöhter Mortalität und langfristigen gesundheitsschädlichen Auswirkungen assoziiert ist, werden weniger als die Hälfte aller Kinder weltweit in den ersten 6 Monaten ausschließlich gestillt. Stillberatung ist eine maßgebliche Intervention, um die Stillraten zu erhöhen. Zielsetzung Ziel dieser Leitlinie ist es, Empfehlungen zur Umsetzung von Stillberatung zu geben, um die Stillpraktiken von Müttern zu verbessern. Methodik Die Leitlinie wurde von der Weltgesundheitsorganisation (WHO) gemäß der im WHO-Handbuch zur Leitlinienentwicklung empfohlenen Methode umgesetzt. Die vorliegende Publikation umfasst die wichtigsten Aspekte der Leitlinie und wurde vom WHO Collaborating Centre an der Donau-Universität Krems (Österreich) auf Deutsch übersetzt. Ergebnisse/Schlussfolgerungen Diese Leitlinie berücksichtigt die aktuelle Evidenz und gibt Empfehlungen und Anmerkungen zur Umsetzung von Stillberatung, wie bspw. zur Häufigkeit, zum optimalen Zeitpunkt, oder zur Art und zu den Anbietern von Stillberatung, um Stillpraktiken zu verbessern. Der Umfang der Leitlinie ist auf diese Umsetzungs-Details beschränkt.

Background and Objectives Rapid reviews provide an efficient alternative to standard systematic reviews in response to a high priority or urgent need. Although rapid reviews of interventions have been extensively evaluated, little is known about the characteristics of rapid reviews of diagnostic evidence. Study Design and Setting We performed a scoping review for rapid reviews of medical tests published from 2013 to 2018. We extracted information on review characteristics and methods used to assess the evidence. Results We identified 191 rapid reviews. All reviews were developed within a short time (less than 12 months) and were relatively concise (less than 10 pages). The reviews involved multiple index tests (44%), multiple outcomes (88%), and several test applications (29%). Well-known methodological tailoring strategies were infrequently used. Although reporting of several key features was limited, we found that, in general, rapid reviews have similar characteristics to broader knowledge syntheses. Conclusion Our scoping review is the first to describe the characteristics and methods of rapid reviews of diagnostic evidence. Future research should identify the most appropriate methods for performing rapid reviews of medical tests. Standards for reporting of rapid reviews are needed.

Hintergrund Die fruhe Kindheit ist eine Zeit in der sich Verhaltensweisen formen und Familien fur Anderungen des Lebensstils offen sind. Ziel Diese Leitlinie gibt Empfehlungen wie viele Stunden Kleinkinder unter 5 Jahren innerhalb von 24 Stunden korperlich aktiv sein oder schlafen sollen, um ihre Gesundheit und ihr Wohlbefinden zu fordern. Methode Die Leitlinie wurde von der Weltgesundheitsorganisation (WHO) gemas WHO-Standards umgesetzt. Die Zusammenfassung wurde von Mitarbeiter/innen des WHO Collaborating Centres an der Donau-Universitat Krems (Osterreich) auf Deutsch ubersetzt. Ergebnisse und Schlussfolgerung Jeder Tag besteht aus Schlafenszeit, niedrig-aktiven Phasen (Sitzen, Stehen, Liegen) und leichter, masiger oder kraftiger korperliche Aktivitat. Kleine Kinder sollten die Moglichkeit haben, sich an entwicklungsgerechter, sicherer und spielbasierter korperlicher Aktivitat zu beteiligen und nicht langer als eine Stunde am Stuck von Bewegung abgehalten werden. Background Early childhood is a time during which a child’s habits are formed and family lifestyle habits are open to changes and adaptations. Objective This guideline provides recommendations on the amount of time during the 24 hours of a day that young children, under 5 years of age, should spend being physically active or sleeping for their health and wellbeing. Method The guideline was developed by the World Health Organization (WHO) in accordance with WHO standards. The summary was translated into German by employees of the WHO Collaborating Center at Danube University Krems (Austria). Results and conclusion A day consists of sleep time, sedentary time and physical activity of light, moderate or vigorous intensity. Young children should have opportunities to participate in a range of developmentally appropriate, safe, enjoyable play-based physical activities.

Background Health policy-makers must often make decisions in compressed time frames and with limited resources. Hence, rapid reviews have become a pragmatic alternative to comprehensive systematic reviews. However, it is important that rapid review methods remain rigorous to support good policy development and decisions. There is currently little evidence about which streamlined steps in a rapid review are less likely to introduce unacceptable levels of uncertainty while still producing a product that remains useful to policy-makers. Methods This paper summarizes current research describing commonly used methods and practices that are used to conduct rapid reviews and presents key considerations and options to guide methodological choices for a rapid review. Results The most important step for a rapid review is for an experienced research team to have early and ongoing engagement with the people who have requested the review. A clear research protocol, derived from a needs assessment conducted with the requester, serves to focus the review, defines the scope of the rapid review, and guides all subsequent steps. Common recommendations for rapid review methods include tailoring the literature search in terms of databases, dates, and languages. Researchers can consider using a staged search to locate high-quality systematic reviews and then subsequently published primary studies. The approaches used for study screening and selection, data extraction, and risk-of-bias assessment should be tailored to the topic, researcher experience, and available resources. Many rapid reviews use a single reviewer for study selection, risk-of-bias assessment, or data abstraction, sometimes with partial or full verification by a second reviewer. Rapid reviews usually use a descriptive synthesis method rather than quantitative meta-analysis. Use of brief report templates and standardized production methods helps to speed final report publication. Conclusions Researchers conducting rapid reviews need to make transparent methodological choices, informed by stakeholder input, to ensure that rapid reviews meet their intended purpose. Transparency is critical because it is unclear how or how much streamlined methods can bias the conclusions of reviews. There are not yet internationally accepted standards for conducting or reporting rapid reviews. Thus, this article proposes interim guidance for researchers who are increasingly employing these methods.

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the benefits and harms of interventions in non-healthcare-related workplaces to reduce the risk of SARS-CoV-2 infection relative to other interventions or no intervention.

Zusammenfassung Ziel Dieser Artikel soll aufzeigen wie Gerechtigkeit im Gesundheitswesen in wichtigen Schritten des Leitlinienentwicklungsprozesses berucksichtigt werden kann. Methode Literaturubersicht gefolgt von Gruppendiskussionen und Konsensfindung. Ergebnisse In den folgenden wichtigen Phasen der Leitlinienentwicklung kann Gerechtigkeit im Gesundheitswesen berucksichtigt werden: Setzen von Prioritaten, Zusammensetzung der Leitliniengruppen, Festlegung der Zielgruppe(n), Formulierung der Leitlinien-Fragen, Auswahl und Gewichtung von Endpunkten und Interventionen, Auswahl der einzuschliesenden Evidenz und nach welcher Evidenz gesucht werden soll, Zusammenfassung der Evidenz und Berucksichtigung zusatzlicher Informationen, Formulierung der Empfehlungen, Nutzung und Evaluation der Leitlinie. Dazu finden sich Beispiele, wie bisherige Leitlinien Gerechtigkeit im Gesundheitswesen in diesen Phasen der Leitlinienentwicklung einbezogen haben. Schlussfolgerung Leitlinienprojekte sollten, wenn es sich um ein Thema handelt, bei dem Gerechtigkeit im Gesundheitswesen eine wichtige Rolle spielt, diese Vorschlage berucksichtigen.

Zusammenfassung Ziel Dieser Artikel beschreibt, warum Gerechtigkeit im Gesundheitswesen bei der Entwicklung von klinischen Leitlinien sowie von Leitlinien im Bereich Public Health oder fur das Gesundheitssystem ausdrucklich berucksichtigt werden soll. Die Methoden werden im Rahmen des GRADE-Ansatzes (GRADE = Grading of Recommendations, Assessment, Development, and Evaluation) vorgestellt. Studiendesign und Setting Es erfolgte eine Suche nach Artikeln zur Methodik der Leitlinienentwicklung, nach konzeptionellen Artikeln zu Gerechtigkeit im Gesundheitswesen und nach Beispielen fur Leitlinien, die diese explizit berucksichtigt hatten. Anschliesend wurde uber die GRADE-Mailing-Liste um Kommentare zu den Ergebnissen gebeten und diese im Rahmen von drei Treffen der GRADE-Workinggroup diskutiert. Ergebnisse Es entstanden drei Artikel, die darlegen, wie man i) Gerechtigkeit im Gesundheitswesen in den gesamten Leitlinien-prozess einbezieht, ii) bei der Bewertung des Vertrauens in die Evidenz berucksichtigt und iii) bei der Erstellung von Evidenzprofilen sowie bei der Ableitung von Empfehlungen und Entscheidungen aus der Evidenz einbindet. Schlussfolgerung Klinische und Public -Health-Leitlinien spielen eine wichtige Rolle in der Forderung von Gerechtigkeit im Gesundheitswesen, indem sie diese explizit in der Entwicklung von Leitlinien berucksichtigen.

Die osterreichische Vorsorgeuntersuchung (VU) wurde 1974 als Kassenleistung eingefuhrt und im Jahr 2005 zum letzten Mal neu gestaltet. Ziel dieser Arbeit war daher, die wissenschaftlichen Grundlagen der VU unter Verwendung des GRADE (Grading of Recommendations Assessment, Development and Evaluation) Ansatzes zu aktualisieren. Die wissenschaftliche Evidenz fur Untersuchungen und Beratungen, die derzeit Teil der VU sind, wurde aktualisiert und um weitere potentiell relevante Untersuchungen erweitert. Vertreter/innen der Bevolkerung diskutierten in drei Fokusgruppen ihre Erwartungen an die VU. In einem strukturierten Prozess wurden von einem Beratungsgremium evidenzbasierte Empfehlungen erarbeitet, welche Untersuchungen/Beratungen Teil der VU sein sollen. Das Beratungsgremium formulierte insgesamt 26 Empfehlungen zu 20 Zielerkrankungen oder Risikofaktoren. Es empfahl erstmals Screening auf abdominales Aortenaneurysma, osteoporotisches Frakturrisiko und chronische Nierenerkrankungen. Screening auf asymptomatische Bakteriurie, Screening auf Eisen‑/Vitamin B12-Mangelanamie und die Identifizierung von Personen mit erhohtem Risiko fur ein Glaukom sollen zukunftig auf Basis der Erkenntnisse nicht mehr in der VU enthalten sein.

Zusammenfassung Hintergrund Risikokommunikation ist ein wesentlicher Bestandteil, um auf Notfälle und Katastrophen, die die Gesundheit der Bevölkerung gefährden, angemessen reagieren zu können. Ziel Die Weltgesundheitsorganisation (WHO) entwickelte diese Leitlinie, um WHO-Mitgliedsstaaten, sowie Stakeholdern aus dem Bereich Notfallschutz und -bekämpfung evidenzbasierte, aktuelle und systemorientierte Handlungsempfehlungen zur Risikokommunikation bereitzustellen. Methode Die Leitlinie wurde gemäß WHO-Standards entwickelt. Ergebnisse Die Leitlinie beinhaltet Empfehlungen zu den Bereichen (1) Vertrauen aufbauen, Unsicherheiten kommunizieren und die betroffene Bevölkerung einbinden, (2) Integration von Risikokommunikation in bestehende Strukturen des Notfallschutz- und der Notfallbekämpfung und (3) Planung, Umsetzung und Evaluierung von Risikokommunikation in der Praxis. Schlussfolgerung Diese Leitlinie gibt Empfehlungen für den Auf- und Ausbau von Risikokommunikation, enthält aber keine Schritt-für-Schritt Anleitungen. Solche detaillierten Anleitungen werden zukünftig in anderer Form von der WHO bereitgestellt.

Background Health promotion programs can only lead to improvements in health outcomes if they are effectively implemented. However, most studies assessing implementation success focus on only one condition, although more conditions influence this process. Therefore, evidence is scarce on what conditions play a role in successful implementation and how they interact. Hence, we aimed to identify which combinations of teacher and implementation process characteristics affected the emotional and social school experience (SCE) of pupils participating in a school-based health promotion program. Methods This study was part of an effectiveness and process evaluation including 24 intervention and 27 control classes. We used fuzzy-set qualitative comparative analysis (fsQCA) to identify combinations of conditions that were associated with either an increase or no increase in the outcome SCE in comparison to the control group at 20 months post intervention. We deductively selected five conditions based on the Consolidated Framework for Implementation Research: teachers’ perceived self-efficacy, teachers’ expectations of the benefits of the intervention, teachers’ previous knowledge about the intervention, dosage of physical activity breaks, and quality of the implementation. Results We identified five different pathways that led to no increase in the pupils’ outcome (parameters of fit: consistency 94%, coverage 66%). The combination of an unsatisfying quality of implementing the intervention and a low previous knowledge about the intervention showed the highest empirical relevance. Similarly, fewer physical activity breaks in combination with other conditions impeded the program’s success. Furthermore, we identified two different pathways characterizing ways to success (consistency: 81%, coverage: 52%). The most relevant combination was good quality implementation of physical activity breaks, implemented by teachers with a high self-efficacy, and a good previous knowledge about the intervention. Conclusions QCA has potential for an in-depth analysis of complex interventions as it can rely on small to medium sample sizes and analyze pathways to success and non-success separately. The investigated program can be improved by considering the following suggestions: The quality of the implementation process should be monitored during the implementation phase, and regular feedback loops and learning opportunities for teachers should accompany a program. Clear recommendations regarding the dosage should be established. Trial registration German register of clinical studies: DRKS00000622. Retrospectively registered: December 3, 2010, (http://www.drks.de/drks_web/setLocale_EN.do). Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107–2010). Electronic supplementary material The online version of this article (10.1186/s12889-018-6284-x) contains supplementary material, which is available to authorized users.

Early childhood is a time during which a child's habits are formed and family lifestyle habits are open to changes and adaptations.This guideline provides recommendations on the amount of time during the 24 hours of a day that young children, under 5 years of age, should spend being physically active or sleeping for their health and wellbeing.The guideline was developed by the World Health Organization (WHO) in accordance with WHO standards. The summary was translated into German by employees of the WHO Collaborating Center at Danube University Krems (Austria).A day consists of sleep time, sedentary time and physical activity of light, moderate or vigorous intensity. Young children should have opportunities to participate in a range of developmentally appropriate, safe, enjoyable play-based physical activities.Die frühe Kindheit ist eine Zeit in der sich Verhaltensweisen formen und Familien für Änderungen des Lebensstils offen sind. ZIEL: Diese Leitlinie gibt Empfehlungen wie viele Stunden Kleinkinder unter 5 Jahren innerhalb von 24 Stunden körperlich aktiv sein oder schlafen sollen, um ihre Gesundheit und ihr Wohlbefinden zu fördern.Die Leitlinie wurde von der Weltgesundheitsorganisation (WHO) gemäß WHO-Standards umgesetzt. Die Zusammenfassung wurde von Mitarbeiter/innen des WHO Collaborating Centres an der Donau-Universität Krems (Österreich) auf Deutsch übersetzt.Jeder Tag besteht aus Schlafenszeit, niedrig-aktiven Phasen (Sitzen, Stehen, Liegen) und leichter, mäßiger oder kräftiger körperliche Aktivität. Kleine Kinder sollten die Möglichkeit haben, sich an entwicklungsgerechter, sicherer und spielbasierter körperlicher Aktivität zu beteiligen und nicht länger als eine Stunde am Stück von Bewegung abgehalten werden.

Background Varicoceles are associated with male subfertility; however, the mechanisms by which varicoceles affect fertility have yet to be satisfactorily explained. Several treatment options exist, including surgical or radiological treatment, however the safest and most efficient treatment remains unclear. OBJECTIVES: To evaluate the effectiveness and safety of surgical and radiological treatment of varicoceles on live birth rate, adverse events, pregnancy rate, varicocele recurrence, and quality of life amongst couples where the adult male has a varicocele, and the female partner of childbearing age has no fertility problems. Search methods We searched the following databases on 4 April 2020: the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. We also searched the trial registries and reference lists of articles. Selection criteria We included randomised controlled trials (RCTs) if they were relevant to the clinical question posed and compared different forms of surgical ligation, different forms of radiological treatments, surgical treatment compared to radiological treatment, or one of these aforementioned treatment forms compared to non-surgical methods, delayed treatment, or no treatment. We extracted data if the studies reported on live birth, adverse events, pregnancy, varicocele recurrence, and quality of life. Data collection and analysis Screening of abstracts and full-text publications, alongside data extraction and 'Risk of bias' assessment, were done dually using the Covidence software. When we had sufficient data, we calculated random-effects (Mantel-Haenszel) meta-analyses; otherwise, we reported results narratively. We used the I2 statistic to analyse statistical heterogeneity. We planned to use funnel plots to assess publication bias in meta-analyses with at least 10 included studies. We dually rated the risk of bias of studies using the Cochrane 'Risk of bias' tool, and the certainty of evidence for each outcome using the GRADE approach. Main results We identified 1897 citations after de-duplicating the search results. We excluded 1773 during title and abstract screening. From the 113 new full texts assessed in addition to the 10 studies (11 references) included in the previous version of this review, we included 38 new studies, resulting in a total of 48 studies (59 references) in the review providing data for 5384 participants. Two studies (three references) are ongoing studies and two studies are awaiting classification. Treatment versus non-surgical, non-radiological, delayed, or no treatment Two studies comparing surgical or radiological treatment versus no treatment reported on live birth with differing directions of effect. As a result, we are uncertain whether surgical or radiological treatment improves live birth rates when compared to no treatment (risk ratio (RR) 2.27, 95% confidence interval (CI) 0.19 to 26.93; 2 RCTs, N = 204; I2 = 74%, very low-certainty evidence). Treatment may improve pregnancy rates compared to delayed or no treatment (RR 1.55, 95% CI 1.06 to 2.26; 13 RCTs, N = 1193; I2 = 65%, low-certainty evidence). This suggests that couples with no or delayed treatment have a 21% chance of pregnancy, whilst the pregnancy rate after surgical or radiological treatment is between 22% and 48%. We identified no evidence on adverse events, varicocele recurrence, or quality of life for this comparison. Surgical versus radiological treatment We are uncertain about the effect of surgical versus radiological treatment on live birth and on the following adverse events: hydrocele formation, pain, epididymitis, haematoma, and suture granuloma. We are uncertain about the effect of surgical versus radiological treatment on pregnancy rate (RR 1.13, 95% CI 0.75 to 1.70; 5 RCTs, N = 456, low-certainty evidence) and varicocele recurrence (RR 1.31, 95% CI 0.82 to 2.08; 3 RCTs, N = 380, low-certainty evidence). We identified no evidence on quality of life for this comparison. Surgery versus other surgical treatment We identified 19 studies comparing microscopic subinguinal surgical treatment to any other surgical treatment. Microscopic subinguinal surgical treatment probably improves pregnancy rates slightly compared to other surgical treatments (RR 1.18, 95% CI 1.02 to 1.36; 12 RCTs, N = 1473, moderate-certainty evidence). This suggests that couples with microscopic subinguinal surgical treatment have a 10% to 14% chance of pregnancy after treatment, whilst the pregnancy rate in couples after other surgical treatments is 10%. This procedure also probably reduces the risk of varicocele recurrence (RR 0.48, 95% CI 0.29, 0.79; 14 RCTs, N = 1565, moderate-certainty evidence). This suggests that 0.4% to 1.1% of men undergoing microscopic subinguinal surgical treatment experience recurrent varicocele, whilst 1.4% of men undergoing other surgical treatments do. Results for the following adverse events were inconclusive: hydrocele formation, haematoma, abdominal distension, testicular atrophy, wound infection, scrotal pain, and oedema. We identified no evidence on live birth or quality of life for this comparison. Nine studies compared open inguinal surgical treatment to retroperitoneal surgical treatment. Due to small sample sizes and methodological limitations, we identified neither treatment type as superior or inferior to the other regarding adverse events, pregnancy rates, or varicocele recurrence. We identified no evidence on live birth or quality of life for this comparison. Radiological versus other radiological treatment One study compared two types of radiological treatment (sclerotherapy versus embolisation) and reported 13% varicocele recurrence in both groups. Due to the broad confidence interval, no valid conclusion could be drawn (RR 1.00, 95% CI 0.16 to 6.20; 1 RCT, N = 30, very low-certainty evidence). We identified no evidence on live birth, adverse events, pregnancy, or quality of life for this comparison. Authors' conclusions Based on the limited evidence, it remains uncertain whether any treatment (surgical or radiological) compared to no treatment in subfertile men may be of benefit on live birth rates; however, treatment may improve the chances for pregnancy. The evidence was also insufficient to determine whether surgical treatment was superior to radiological treatment. However, microscopic subinguinal surgical treatment probably improves pregnancy rates and reduces the risk of varicocele recurrence compared to other surgical treatments. High-quality, head-to-head comparative RCTs focusing on live birth rate and also assessing adverse events and quality of life are warranted.

Background Seasonal affective disorder (SAD) is a seasonal pattern of recurrent depressive episodes that is often treated with second-generation antidepressants (SGAs), light therapy, or psychotherapy. Objectives To assess the efficacy and safety of second-generation antidepressants (SGAs) for the treatment of seasonal affective disorder (SAD) in adults in comparison with placebo, light therapy, other SGAs, or psychotherapy. Search methods This is an update of an earlier review first published in 2011. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 1) in the Cochrane Library (all years), Ovid MEDLINE, Embase, and PsycINFO (2011 to January 2020), together with the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) (all available years), for reports of randomised controlled trials (RCTs). We hand searched the reference lists of all included studies and other systematic reviews. We searched ClinicalTrials.gov for unpublished/ongoing trials. We ran a separate update search for reports of adverse events in the Ovid databases. SELECTION CRITERIA: For efficacy we included RCTs of SGAs compared with other SGAs, placebo, light therapy, or psychotherapy in adult participants with SAD. For adverse events we also included non-randomised studies. Data collection and analysis Two review authors independently screened abstracts and full-text publications against the inclusion criteria. Data extraction and 'Risk of bias' assessment were conducted individually. We pooled data for meta-analysis where the participant groups were similar, and the studies assessed the same treatments with the same comparator and had similar definitions of outcome measures over a similar duration of treatment. Main results In this update we identified no new RCT on the effectiveness of SGAs in SAD patients. We included 2 additional single-arm observational studies that reported on adverse events of SGAs. For efficacy we included three RCTs of between five and eight weeks' duration with a total of 204 participants. For adverse events we included two RCTs and five observational (non-randomised) studies of five to eight weeks' duration with a total of 249 participants. All participants met the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for SAD. The average age ranged from 34 to 42 years, and the majority of participants were female (66% to 100%). Results from one trial with 68 participants showed that fluoxetine (20/36) was numerically superior to placebo (11/32) in achieving clinical response; however, the confidence interval (CI) included both a potential benefit as well as no benefit of fluoxetine (risk ratio (RR) 1.62, 95% CI 0.92 to 2.83, very low-certainty evidence). The number of adverse events was similar in both groups (very low-certainty evidence). Two trials involving a total of 136 participants compared fluoxetine versus light therapy. Meta-analysis showed fluoxetine and light therapy to be approximately equal in treating seasonal depression: RR of response 0.98 (95% CI 0.77 to 1.24, low-certainty evidence), RR of remission 0.81 (95% CI 0.39 to 1.71, very low-certainty evidence). The number of adverse events was similar in both groups (low-certainty evidence). We did not identify any eligible study comparing SGA with another SGA or with psychotherapy. Two RCTs and five non-randomised studies reported adverse event data on a total of 249 participants who received bupropion, fluoxetine, escitalopram, duloxetine, nefazodone, reboxetine, light therapy, or placebo. We were only able to obtain crude rates of adverse events, therefore caution is advised regarding interpretation of this information. Between 0% and 100% of participants who received an SGA suffered an adverse event, and between 0% and 25% of participants withdrew from the study due to adverse events. Authors' conclusions Evidence for the effectiveness of SGAs is limited to one small trial of fluoxetine compared with placebo showing a non-significant effect in favour of fluoxetine, and two small trials comparing fluoxetine against light therapy suggesting equivalence between the two interventions. The lack of available evidence precluded us from drawing any overall conclusions on the use of SGAs for SAD. Further, larger RCTs are required to expand and strengthen the evidence base on this topic, and should also include comparisons with psychotherapy and other SGAs. Data on adverse events were sparse, and a comparative analysis was not possible. The data we obtained on adverse events is therefore not robust, and our confidence in the data is limited. Overall, up to 25% of participants treated with SGAs for SAD withdrew from the study early due to adverse events.

During the COVID-19 pandemic, many health-related questions require rapid answers. In the Competence Network Public Health COVID-19, founded by representatives of several scientific societies in March 2020, rapid reviews are often conducted to generate evidence-based answers that are useful for policy makers. The aim of this paper is to reflect on the practical experience with rapid reviews in the context of the Competence Network Public Health. Methods for high-quality and practicable implementation of rapid reviews were developed, which are particularly helpful for rapid evidence generation based on observational studies.Using the 8-step approach proposed by Tricco et al. [1], we describe the acute challenges that have arisen in the Public Health Competence Network COVID-19 while conducting rapid reviews on public health-related issues related to the COVID-19-pandemic. The 8 steps are: 1. conceptualization of the research question, 2. literature search, 3. title/abstract and full text screening, 4. data extraction, 5. risk of bias assessment, 6. evidence synthesis, 7. dissemination, 8. update. We develop a methodological approach for conducting rapid reviews by expert consensus of the members (n=42 as of 01/28/2021) of the Rapid Reviews Working Group in the Competence Network Public Health COVID-19.A standardized approach is presented that closely follows the approach of the Cochrane Rapid Reviews Methods Group and takes into account the special requirements of etiological - but often also ecological - observational studies on COVID-19.The proposed approach for conducting rapid reviews can form an important basis for evidence-based policy advice - certainly beyond questions related to COVID-19. Flexible and rapid funding concepts should be made available for the short-term realization of methodologically high-quality rapid reviews on emerging questions. Scientific cooperation in conducting rapid reviews needs to be expanded, and more methodologically high-quality approaches such as prospective meta-analyses should be used.ZIEL: Im Zuge der COVID-19-Pandemie benötigen viele gesundheitsrelevante Fragestellungen rasche Antworten. Im Kompetenznetz Public Health zu COVID-19, das im März 2020 von Vertreter:innen mehrerer wissenschaftlicher Fachgesellschaften gegründet wurde, werden vielfach Rapid Reviews erstellt, um rasch evidenzbasierte, für politische Entscheidungsträger:innen nutzbare Antworten zu generieren. Ziel dieses Beitrags ist es, die praktischen Erfahrungen bei der Durchführung von Rapid Reviews im Rahmen des Kompetenznetzes Public Health zu reflektieren. Auf dieser Grundlage sollen Methoden zur qualitativ hochwertigen und praktikablen Durchführung von Rapid Reviews entwickelt werden, die insbesondere auch zur raschen Evidenzgenerierung auf der Grundlage von Beobachtungsstudien anwendbar sind.Unter Nutzung des von Tricco et al. [1] vorgeschlagenen 8-schrittigen Vorgehens werden die aktuellen Herausforderungen beschrieben, die sich im Kompetenznetz Public Health zu COVID-19 bei der Durchführung von Rapid Reviews zu Public Health-bezogenen Fragen der COVID-19-Pandemie ergeben haben. Die 8 Schritte lauten: 1. Formulierung der Fragestellung, 2. Literatursuche, 3. Titel-Abstract- und Volltextsichtung, 4. Datenextraktion, 5. Risk of Bias-Bewertung, 6. Evidenzsynthese, 7. Dissemination, 8. Aktualisierung. Zudem werden Lösungsvorschläge im Expert:innenkonsens der Mitglieder (n=42 zum 28.01.2021) der Querschnitts-AG Rapid Reviews des Kompetenznetzes Public Health zu COVID-19 entwickelt.Vorgelegt und zur Diskussion gestellt wird ein standardisiertes Vorgehen, das sich eng an das Vorgehen der Cochrane Rapid Reviews Methods Group anlehnt und den besonderen Anforderungen von ätiologisch orientierten, häufig auch ökologischen Beobachtungsstudien zu COVID-19 Rechnung trägt.Das vorgeschlagene Vorgehen bei der Durchführung von Rapid Reviews kann – ggf. über Fragestellungen zu COVID-19 hinaus – eine wichtige Grundlage einer evidenzbasierten Politikberatung bilden. Zur kurzfristigen Realisierung von methodisch hochwertigen Rapid Reviews zu neuen Fragestellungen sollten flexible und kurzfristig aktivierbare Förderkonzepte bereitgestellt werden. Wissenschaftliche Kooperationen bei der Durchführung von Rapid Reviews sollten ausgebaut werden, dabei sollten verstärkt methodisch hochwertige Ansätze wie bspw. prospektive Metaanalysen Anwendung finden.

Objectives To develop methods guidance to support the conduct of rapid reviews (RRs) produced within Cochrane and beyond, in response to requests for timely evidence syntheses for decision-making purposes including urgent health issues of high priority. Study Design and Setting Interim recommendations were informed by a scoping review of the underlying evidence, primary methods studies conducted, and a survey sent to 119 representatives from 20 Cochrane entities, who were asked to rate and rank RR methods across stages of review conduct. Discussions among those with expertise in RR methods further informed the list of recommendations with accompanying rationales provided. Results Based on survey results from 63 respondents (53% response rate), 26 RR methods recommendations are presented for which there was a high or moderate level of agreement or scored highest in the absence of such agreement. Where possible, how recommendations align with Cochrane methods guidance for systematic reviews is highlighted. Conclusion The Cochrane Rapid Reviews Methods Group offers new, interim guidance to support the conduct of RRs. Because best practice is limited by the lack of currently available evidence for some RR methods shortcuts taken, this guidance will need to be updated as additional abbreviated methods are evaluated.

Objective: We aimed to map the resource use during systematic review (SR) production and reasons why steps of the SR production are resource intensive to discover where the largest gain in improving efficiency might be possible., Study design and setting: We conducted a scoping review. An information specialist searched multiple databases (e.g., Ovid MEDLINE, Scopus) and implemented citation-based and grey literature searching. We employed dual and independent screenings of records at the title/abstract and full-text levels and data extraction., Results: We included 34 studies. Thirty-two reported on the resource use-mostly time; four described reasons why steps of the review process are resource intensive. Study selection, data extraction, and critical appraisal seem to be very resource intensive, while protocol development, literature search, or study retrieval take less time. Project management and administration required a large proportion of SR production time. Lack of experience, domain knowledge, use of collaborative and SR-tailored software, and good communication and management can be reasons why SR steps are resource intensive., Conclusion: Resource use during SR production varies widely. Areas with the largest resource use are administration and project management, study selection, data extraction, and critical appraisal of studies., peer-reviewed

Background and Objective Rapid reviews were first mentioned in the literature in 1997, when Best et al. described the rapid health technology assessment program in the south and west regions of England but did not provide a formal definition. More recently, the only consensus around a rapid review definition is that a formal definition does not exist. The primary aim of this work is to create a repository of existing definitions and to identify key themes, which may help the knowledge synthesis community in defining rapid review products. Methods A systematic scoping review was performed to identify definitions used in journal-published rapid reviews written in English between 2017 and January 2019. We searched Medline, Embase Classic + Embase, PsycINFO, ERIC, Cochrane Library, CINAHL, and Web of Science on December 21, 2018. Two reviewers performed study selection and data extraction using a priori–defined methods published in a protocol. Definitions from rapid review methods articles (published from 1997 onward) identified in another scoping review were added to the results, and all definitions were thematically analyzed using NVivo. A quantitative analysis was also performed around studies cited. Results Definitions from 216 rapid reviews and 90 rapid review methods articles were included in the thematic analysis. Eight key themes were identified: accelerated/rapid process or approach, variation in methods shortcuts, focus/depth/breadth of scope, compare and contrast to a full traditional systematic review, stakeholder rationale, resource efficiency rationale, systematic approach, bias/limitations. Secondary referencing was a common occurrence. Conclusion Thematic analysis performed in this systematic scoping review has allowed for the creation of a suggested definition for rapid reviews that can be used to inform the systematic review community.

This qualitative study investigates factors that may impede or facilitate inclusion of systematic evidence assessments in academic clinical trials using interviews with Swiss stakeholders and international funders., Key Points Question What are the practices and attitudes of Swiss stakeholders and international funders regarding conducting systematic evidence assessments in academic clinical trials? Findings In this qualitative study in which 48 Swiss clinical trial stakeholders and 9 international funders were interviewed, responses varied widely regarding how previous evidence should be summarized and assessed when planning a new clinical trial. A lack of obligation, time, competent support, and financial resources was identified as a barrier for an evidence-based approach. Meaning There may be a need for more explicit requirements from funders and ethics committees to clarify the level of comprehensiveness needed in summarizing existing evidence for different types of clinical trials., Importance A systematic assessment of existing research should justify the conduct and inform the design of new clinical research but is often lacking. There is little research on the barriers to and factors facilitating systematic evidence assessments. Objective To examine the practices and attitudes of Swiss stakeholders and international funders regarding conducting systematic evidence assessments in academic clinical trials. Design, Setting, and Participants In this qualitative study, individual semistructured qualitative interviews were conducted between February and August 2020 with 48 Swiss stakeholder groups (27 primary investigators, 9 funders and sponsors, 6 clinical trial support organizations, and 6 ethics committee members) and between January and March 2021 with 9 international funders of clinical trials from North America and Europe with a reputation for requiring systematic evidence synthesis in applications for academic clinical trials. Main Outcomes and Measures The main outcomes were practices and attitudes of Swiss stakeholders and international funders regarding conducting systematic evidence assessments in academic clinical trials. Interviews were analyzed using conventional content analysis. Results Of the 57 participants, 40 (70.2%) were male. Participants universally acknowledged that a comprehensive understanding of the previous evidence is important but reported wide variation regarding how this should be achieved. Participants reported that the conduct of formal systematic reviews was currently not expected before most clinical trials, but most international funders reported expecting a systematic search for the existing evidence. Whereas time and resources were reported by all participants as barriers to conducting systematic reviews, the Swiss research ecosystem was reported not to be as supportive of a systematic approach compared with international settings. Conclusions and Relevance In this qualitative study, Swiss stakeholders and international funders generally agreed that new clinical trials should be justified by a systematic evidence assessment but that barriers on individual, organizational, and political levels kept them from implementing it. More explicit requirements from funders appear to be needed to clarify the required level of comprehensiveness in summarizing existing evidence for different types of clinical trials.