Key Message

For adults who are iron deficient before elective surgery, patients who received IV iron supplementation may have greater increases in hemoglobin and ferritin concentrations, similar or lower lengths of stay in hospital, and similar quality of life measures, functional outcomes, and rates of adverse events, compared to patients who did not receive IV supplementation. The findings were mixed for the rate of blood transfusions.

For adults who are iron deficient before elective surgery, patients who received IV iron supplementation may experience similar changes in hemoglobin levels, quality of life scores, or number of adverse events when compared to patients who received oral iron supplementation. The findings were mixed regarding the risk of blood transfusions.

No studies were found on the cost-effectiveness of IV iron preparation therapy for patients who are iron deficient undergoing elective surgery that met the criteria for this review.

One guideline recommends the use of IV iron supplementation for patients with iron deficient anemia when surgery is less than 8 weeks away, patients are unable to tolerate or absorb oral iron supplementation, or for patient with suboptimal hemoglobin levels.

Key Message

• Continuous glucose monitoring (CGM) is a method of glucose testing in which a sensor is inserted into the skin and continuously monitors interstitial glucose concentrations. Real-time continuous glucose monitoring (rtCGM) systems automatically measure glucose and display a recent glucose value.
• Evidence suggests that rtCGM may improve hemoglobin A1C and time in range in adults and pediatric patients with type 1 diabetes, but this is uncertain.
• Limited evidence suggests that in people with type 1 diabetes, there is little to no difference between rtCGM and self-monitoring of blood glucose (SMBG) on quality of life, diabetic ketoacidosis, and severe adverse events.
• Safety evidence suggests that rtCGM may decrease severe hypoglycemia in adults and pediatric patients with type 1 diabetes, but this is uncertain.
• rtCGM may be more cost-effective in the long term than SMBG in adults with type 1 diabetes.

Key Message

• For antipsychotic-related sexual dysfunction, 1 guideline recommends switching to aripiprazole or another non-hyperprolactinemic antipsychotic as the first option. Alternatively, the guideline recommends adjunctive treatment with aripiprazole, or switching to antipsychotics that have less impact on sexual function. Another guideline recommends adding estrogen or testosterone treatment to the antipsychotic medication to assist sexual dysfunction in women.
• For antidepressant-related sexual dysfunction, 1 guideline recommends switching to agomelatine or to a non-serotonergic drug or fluvoxamine as first option. Alternatively, the guideline recommends switching to a partially non-serotonergic antidepressant, adding antidotes, or using vaginal lubricants.

Key Message

• Mepivacaine was found to have statistically significantly better results than bupivacaine for various specific measurements related to neurologic symptoms, mobility, length of stay, urinary retention, and adverse events and safety; however, for the overall evidence, the difference in outcomes between the 2 did not consistently reach the level of statistical significance.
• The overall evidence for postoperative pain largely found no statistically significant difference between mepivacaine and bupivacaine, except for proportion of postoperative zero pain, where mepivacaine resulted in a statistically greater proportion of patients reporting zero pain postoperatively than bupivacaine.
• Evidence was only identified for individuals who received either total hip arthroplasty or total knee arthroplasty, and thus the findings presented in this report may not be generalizable to other total joint reconstruction or replacement surgeries.
• No evidence was identified regarding the cost-effectiveness or evidence-based guidelines for the use of mepivacaine versus bupivacaine for total joint arthroplasty.

Key Message

Reactive air surfaces, alternating-pressure (active) air surfaces, and reactive gel surfaces may be more effective at preventing pressure injuries compared to foam surfaces. The clinical effectiveness of therapeutic support surfaces to prevent pressure injuries may be influenced by the care setting (e.g., long-term care, acute care, intensive care units) as well as follow-up time.

An overview of reviews with a network meta-analysis did not find any significant differences between different types of support surfaces on time to pressure injury. However, limited evidence suggests there may be a difference between foam surfaces, compared to other types of foam surfaces.

Specialized skin protection cushions may also help to prevent pressure injuries compared to standard foam cushions, though there may be no difference between different types of air cushions.

It was unclear if there are significant differences between support surfaces for the treatment of pressure injuries. Authors of an overview of reviews stated that reactive air surfaces may be more effective than foam surfaces, but this was not statistically significant.

Limited evidence was identified regarding adverse events and health-related quality of life, as well as for pediatric patients.

Limited evidence was identified for support surfaces other than mattresses, beds, and overlays (e.g., cushions), as well as therapeutic small devices for prevention of pressure injuries. No studies were identified for therapeutic small devices for treatment.

Key Message

• Evidence is inconsistent and of very low to moderate quality for the clinical effectiveness of cannabis regarding treatment retention and adherence, craving and withdrawal symptoms, or illicit opioid or other substance use. There is lack of consensus in the included publications as to whether use of cannabis in opioid use disorder is beneficial or detrimental.
• No evidence of an impact of cannabis on quality of life, functioning, satisfaction, relapse, hospitalizations, or overdoses in people with opioid use disorder was identified.
• One evidence-based guideline developed by health care and allied health professionals in Canada strongly recommends against the use of cannabinoids for the treatment of opioid use disorder in the primary care setting due to no or inconclusive evidence.

Key Message

A 2022 UK guideline recommends that the liposuction procedure for treatment of lipedema should only be used in the context of research because of inadequate efficacy and safety data.

A 2021 US guideline recognizes that liposuction is currently the only available technique for removing abnormal lipedema tissue. The guideline has a series of consensus statements on patient selection, indications for liposuction, prevention of procedure-related adverse events, and pre- and post-surgical management.

There were no recent studies on the clinical effectiveness of liposuction compared with no treatment or to alternative treatments for the treatment of lipedema.