Key Message

Intranasal glucagon was equally effective compared with glucagon given by intramuscular or subcutaneous injection to treat experimentally insulin-induced hypoglycemia in both adults and children with type 1 diabetes.

The overall rates of adverse events were similar between groups treated with intranasal glucagon or intramuscular or subcutaneous glucagon. Nausea and vomiting were more frequent in the groups treated with intramuscular or subcutaneous glucagon, whereas eye and nose symptoms occurred more frequently in the intranasal glucagon group.

There was no evidence identified that compared the clinical effectiveness of intranasal glucagon with placebo or no treatment in people treated with insulin who received treatment for hypoglycemia.

No evidence was found about the cost-effectiveness of intranasal glucagon and no evidence-based guidelines were found about the use of intranasal glucagon for the treatment of hypoglycemia in people who receive treatment with insulin.

Key Message

One non-randomized study was identified about the clinical effectiveness of behaviourally based interventions that are primary carefeasible or primary carereferable for vaping prevention in children and adolescents.

Key Message

There is some evidence of benefit of melatonin compared with placebo for the short-term treatment of insomnia in children and adolescents with neurodisabilities.

The short-term safety profile of melatonin suggested that it was well-tolerated, although some severe adverse events may occur. There was a lack of long-term safety data.

The American Academy of Neurology guideline recommends high-grade melatonin should be prescribed for treatment of sleep disturbance in children and adolescents with autism spectrum disorder if first-line treatment with behavioural strategies is not helpful.

Evidence comparing the clinical effectiveness of melatonin with prescription sedatives for the treatment of insomnia in children and adolescents was not identified.

No evidence was found regarding the cost-effectiveness of melatonin compared with placebo or prescription sedatives for the treatment of insomnia in children and adolescents.

Key Message

Two systematic reviews and 4 randomized controlled trials were identified about the clinical effectiveness of behaviourally based interventions that are primary carefeasible or primary carereferable for tobacco smoking prevention in children and adolescents.

Key Message

Two umbrella reviews, 7 systematic reviews, and 2 randomized controlled trials provided mixed results on the clinical effectiveness of melatonin for insomnia, when compared to placebo. Some studies reported improvement in sleep and quality of life outcomes with melatonin, and some studies reported no difference between patients who received melatonin and those who received placebo. Efficacy of melatonin was measured both objectively (e.g., polysomnography, actigraphy) and subjectively (e.g., validated questionnaires, sleep diaries), and was measured across multiple outcomes. Two guidelines recommend melatonin for insomnia, but the strength of the recommendations was not reported. One guideline recommends melatonin for insomnia, based on very low evidence (but the evidence was unclear). One guideline recommends against melatonin for chronic insomnia disorder (weak recommendation). The evidence for these recommendations was not well reported across the guidelines. No studies were found that evaluated the clinical effectiveness of melatonin compared to prescription sedatives in people with insomnia that met the criteria for this review. No studies were found for the cost-effectiveness of melatonin in people with insomnia that met the criteria for this review.

Key Message

Findings from 3 diagnostic accuracy studies indicate that individual tests are insufficient to diagnose vitamin B12 deficiency, and a testing strategy that uses homocysteine and methylmalonic acid should be used in individuals suspected or at risk of vitamin B12 deficiency. This is supported by a health technology assessment that concluded that the current evidence does not provide enough information to determine the most appropriate test, or combination of tests to use in these patients.

The patient populations varied in the primary studies included in the systematic reviews and in the primary studies identified in this review, which may impact the generalizability of the results.

Reference standards and cut-off values (i.e., thresholds) used to diagnose vitamin B12 deficiency varied in the primary studies. Presentation of units (e.g., pg/mL, pmol/L) also varied, making it difficult to compare results across studies.

No studies were identified that evaluated the clinical utility of vitamin B12 testing in people with suspected vitamin B12 deficiency.

No studies were identified that evaluated the cost-effectiveness of vitamin B12 testing in people with suspected vitamin B12 deficiency.

No evidence-based guidelines were identified regarding the use of vitamin B12 testing in people with suspected vitamin B12 deficiency.

Key Message

One health technology assessment and 6 non-randomized studies were identified regarding the diagnostic test accuracy of transcutaneous bilirubin screening compared with serum bilirubin testing for well newborns in hospital. One health technology assessment and 1 randomized controlled trial were identified regarding the clinical effectiveness of transcutaneous bilirubin for well newborns in hospital. One health technology assessment and 1 economic evaluation were identified regarding the cost-effectiveness of transcutaneous bilirubin screening for well newborns in hospital. One evidence-based guideline was identified regarding transcutaneous bilirubin screening for well newborns in hospital.

Key Message

A preponderance of evidence identified in this review indicates a relative benefit in the clinical effectiveness of heroin-assisted treatment, injectable hydromorphone, or diacetylmorphine compared to methadone in patients with opioid use disorder. Most of the evidence in this review describing sustained-release oral morphine versus methadone shows no significant difference in measures of clinical effectiveness for patients with opioid use disorder. There is a lack of evidence reported in systematic reviews and randomized controlled trials describing the clinical effectiveness of oral hydromorphone, fentanyl patches, and fentanyl buccal tablets. Most of the evidence in this review, describing various forms of opioid substitution treatments, has been characterized as low quality and draws from the same several trials.

Key Message

The clinical effectiveness of floatation therapy for the treatment of physical conditions remains uncertain. One randomized controlled trial was identified that evaluated floatation-restricted environmental stimulation therapy (REST) compared with placebo and waitlist control groups for the treatment of patients with chronic pain. The trial reported no significant differences between the 3 treatment groups on any of the outcomes measured including those related to pain, medication use, quality of life, sleep impairment, anxiety, or depression. One guideline was identified that states that there is insufficient evidence to recommend for or against the use of sensory deprivation tanks in patients with symptoms attributed to mild traumatic brain injury. The cost-effectiveness of floatation therapy for the treatment of physical condition is unknown as no relevant economic evaluations were identified.