Key Message

No studies were found that evaluated the clinical effectiveness of aprepitant for the prevention of post-operative nausea and vomiting in patients with a history of post-operative nausea and vomiting refractory to conventional antiemetic prophylaxis that met the criteria for this review.

In patients with the potential for life-threatening post-operative medical complications due to emesis, limited evidence of variable quality was identified for the clinical effectiveness of aprepitant. The studies varied by population, the combination of interventions and comparators and the outcomes measured, and the findings were mixed.

No studies were found that evaluated the cost-effectiveness of aprepitant for the prevention of post-operative nausea and vomiting in patients with a history of post-operative nausea and vomiting refractory to conventional antiemetic prophylaxis that met the criteria for this review.

No studies were found that evaluated the cost-effectiveness of aprepitant for the prevention of post-operative nausea and vomiting in patients with the potential for life-threatening post-operative medical complications due to emesis that met the criteria for this review.

No evidence-based guidelines were found regarding the use of aprepitant for the prevention of post-operative nausea and vomiting in patients with a history of post-operative nausea and vomiting refractory to conventional antiemetic prophylaxis that met the criteria for this review.

No evidence-based guidelines were found regarding the use of aprepitant for the prevention of post-operative nausea and vomiting in patients with the potential for life-threatening post-operative medical complications due to emesis that met the criteria for this review.

Key Message

The evidence about the clinical effectiveness of reconsolidation and consolidation therapies for the treatment and prevention of post-traumatic stress disorder (PTSD) is uncertain because these therapies include a wide range of interventions and the study results varied widely.

The results from 1 systematic review suggest there were significantly greater improvements in PTSD severity in patients treated with reconsolidation therapy versus control. However, 3 other systematic reviews reported conflicting findings with some reconsolidation therapies indicating significant improvements in PTSD symptoms or severity versus control, whereas other reconsolidation therapies had no significantly different outcomes than the control groups.

There was limited evidence suggesting that multi-modular motion-assisted memory desensitization and reprocessing therapy reduced PTSD symptoms in veterans with treatment-resistant and combat-related PTSD; however, the significance of these results was not reported.

There was limited evidence suggesting a significant difference in PTSD incidence in favour of adults exposed to trauma treated with hydrocortisone versus control. There were no significant differences in PTSD incidence between adults exposed to trauma treated with any 1 of propranolol, omega-3 fatty acids, gabapentin, or paroxetine versus placebo.

Key Message

The use of robotic systems to aid in surgical procedures, including spinal surgeries, has been on the rise over the past several years. Systematic reviews and economic evaluations on the clinical and cost-effectiveness of robotic-assisted surgical systems used for patients requiring spinal surgeries that do not involve pedicle screw placement are lacking.

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

Evidence from 1 systematic review and 2 observational studies suggests that dexamethasone intravitreal implant is associated with improvement in macular edema secondary to retinal detachment surgery.

The evidence primarily came from low- to moderate-quality studies.

It is challenging to draw definitive conclusions about the effectiveness of this intervention because of the paucity of data, the lack of controlled clinical studies, and the retrospective nature of the current literature.

No evidence was identified on the cost-effectiveness of dexamethasone intravitreal implant for the treatment of macular edema secondary to retinal detachment surgery.

Key Message

Variable findings were reported for clinical effectiveness of melatonin for the prevention or treatment of delirium compared with placebo in the literature that met the criteria for this review.

No studies that met the criteria for this review were found on the clinical effectiveness of melatonin for the prevention and/or treatment of delirium versus antipsychotic drugs or cholinergic agents.

There was limited evidence available on the clinical effectiveness of melatonin for the prevention and/or treatment of delirium versus dexmedetomidine.

There were no statistically or clinically significant harms reported from the use of melatonin in the treatment of patients at risk from or experiencing delirium.

Limited guidance was found that provided recommendations for the use of melatonin in the prevention and//or treatment of delirium for hospitalized inpatients.

Key Message

The evidence in this report is limited because statistical information was not adequately reported in included studies.

When comparing second-generation paliperidone palmitate injections and first-generation haloperidol decanoate injections, there is little-to-no difference in treatment success or adverse events.

When comparing second-generation risperidone injections and first-generation haloperidol decanoate and fluphenazine decanoate injections given together, there is little-to-no difference in whether patients discontinue treatment.

Hospitalization appears higher for patients who receive haloperidol decanoate injections compared to those who receive second-generation risperidone or aripiprazole injections, but there is little-to-no difference when comparing injections of risperidone to those of haloperidol decanoate and fluphenazine decanoate given together.

There is little-to-no difference between patients who stop treatment when comparing risperidone injections to any oral second-generation antipsychotics, second-generation olanzapine injections compared to oral olanzapine, or aripiprazole injections compared to oral aripiprazole. There is little-to-no difference in adverse events between patients given aripiprazole injections compared to those given oral aripiprazole.

Some studies showed a difference in relapse between second-generation injections compared to oral second-generation medication, while other studies showed little-to-no differences.

Patients may experience fewer hospital days when given olanzapine injections compared to those receiving oral olanzapine.