Key Message

What Is the Issue?

• Ovarian cancer is a common gynecological malignancy, with the highest mortality rate. Presently, there are no screening tools that can detect ovarian cancer at an early stage. As a result, there is a need for other preventive options.
• Recent research suggests that the most common type of ovarian malignancy may originate in parts of the fallopian tube rather than the ovary itself.
• Bilateral opportunistic salpingectomy involves removal of both fallopian tubes while a person is undergoing abdominal surgery for another indication (e.g., a partial hysterectomy, Caesarean section), while leaving the ovaries intact. This procedure may be a possible prevention strategy for ovarian cancer, and it is therefore important to understand its potential harms and benefits.

What Did We Do?

• To inform decisions about bilateral opportunistic salpingectomy to reduce the incidence of ovarian cancer in people at general population risk of the disease, we sought to identify and summarize literature examining the safety and efficacy of bilateral opportunistic salpingectomy compared with other abdominal surgeries without bilateral opportunistic salpingectomy. We also aimed to identify and summarize information on the cost-effectiveness of, and recommendations regarding best practices for, bilateral opportunistic salpingectomy in this population.
• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since January 1, 2019.

What Did We Find?

• Outcomes related to the benefits and harms for bilateral opportunistic salpingectomy are mixed, compared with tubal ligation. People who undergo bilateral opportunistic salpingectomy may experience longer surgical times, fill more prescriptions for pain medication, but experience fewer perioperative complications and be less likely to have postoperative ultrasounds and laboratory visits (1 retrospective cohort study). There may not be any statistically significant differences in endocrine function and other postoperative adverse events between the 2 groups (1 systematic review [SR], 1 retrospective cohort study).
• Outcomes related to the benefits and harms for hysterectomy with bilateral opportunistic salpingectomy are mixed, compared with hysterectomy alone. People who undergo bilateral opportunistic salpingectomy may experience longer hospital stays and greater risk of menopausal symptoms 1 year after surgery, but less perioperative bleeding (2 retrospective cohort studies). There may not be any statistically significant differences in blood transfusions, duration of surgery, or other postoperative outcomes (1 retrospective cohort study). There may be no difference in menopause onset 4 weeks to 6 months after surgery, but a shorter time to menopause in the bilateral opportunistic salpingectomy group when followed up for 5 years (1 SR, 1 retrospective cohort study).
• None of the included studies reported on the incidence of ovarian cancer.
• We did not find any evidence-based guidelines or economic evaluations regarding the use of bilateral opportunistic salpingectomy to reduce the incidence of ovarian cancer.

What Does It Mean?

• The available evidence suggests that the benefits and harms of bilateral opportunistic salpingectomy vary, compared with both tubal ligation and hysterectomy alone. To inform future clinical practice, decision-makers may want to consider these potential risks and benefits.
• Findings from the included SRs were rated as low to very low certainty and should be interpreted accordingly. Additional clinical studies would help strengthen the evidence base and provide a better understanding of the benefits and harms of bilateral opportunistic salpingectomy for people at general population risk of ovarian cancer.
• Longitudinal studies that examine the incidence of ovarian cancer in this population would help illustrate the clinical effectiveness of this procedure.

Key Message

What Is the Issue?

• The volume of ophthalmic surgeries is increasingly high, with cataract surgery being 1 of the most performed surgeries in Canada.
• Infections following ophthalmic surgeries, while rare, can cause severe complications that may lead to irreversible vision loss. Reducing postsurgery infections is a high priority in clinical practice.
• Running a full wrapped, terminal steam sterilization cycle for ophthalmic instruments in autoclaves may be inefficient for ophthalmic surgeries and may cause unnecessary heavy economic and environmental burdens due to high surgical volumes.
• Using instruments sterilized on a short cycle between sequential same-day ophthalmic surgeries may help improve efficiency and reduce resources used. These instruments are generally processed using autoclaves (i.e., steam sterilizers); the effectiveness of a shorter-cycle method of sterilization is unclear.

What Did We Do?

• To inform decisions regarding the use of autoclaves for short-cycle sterilization for sequential same-day instrument use in ophthalmic surgery, we sought to identify and summarize evidence comparing this method to full-cycle sterilization of wrapped instruments and identify any relevant recommendations.
• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2012. One reviewer screened articles for inclusion based on predefined criteria.

What Did We Find?

• In a laboratory setting to simulate sequential same-day procedures, short-cycle sterilization with interrupted dry time for unwrapped ophthalmic instruments is feasibly as effective as full-cycle sterilization for wrapped instruments using the STATIM autoclave. Similarly, short-cycle sterilization with interrupted dry time for contained ophthalmic instruments is feasibly as effective as full-cycle sterilization for contained instruments using the AMSCO autoclave.
• For sequential same-day ophthalmic procedures, wet instruments sterilized by a short-cycle process with an interrupted dry time can remain sterile for at least 3 minutes if kept in a covered sterilizer containment device.
• One guideline recommends that wrapped or unwrapped ophthalmic instruments sterilized by a short-cycle process without full drying should be stored in a covered containment device until retrieved by staff wearing sterile gloves and gowns in the operating room for the subsequent surgery after a short delay. Phaco handpieces should be immediately primed with a balanced salt solution and remain wet as they sit on the sterile instrument table.
• We did not identify any clinical setting evidence from studies or autoclave manufacturers. It is unclear if clinical outcomes differ between patients undergoing sequential same-day ophthalmic surgeries using short-cycle sterilized instruments and those undergoing surgery using full-cycle sterilized instruments.

What Does This Mean?

• Preliminary laboratory evidence and guideline recommendations supporting the use of autoclaves for short-cycle sterilization of instruments for sequential same-day ophthalmic surgeries are available. However, there is no clinical effectiveness evidence available on this process in patient settings.
• Future research is necessary to understand the clinical safety of using instruments sterilized by short cycles for sequential same-day use for patients undergoing ophthalmic surgeries.
• In addition to the evidence and recommendations identified, other factors, such as environmental influence, may be useful considerations when making decisions about short-cycle sterilization for sequential same-day instrument use for ophthalmic surgery.
   

Key Message

What is the Issue?

Children with hearing loss may experience delays in language, speech, and cognitive development, which can have long lasting implications if unaddressed.  

Early hearing detection and intervention programs aim to identify and avoid long term impacts of hearing loss for infants and children. Interventions include the use of hearing devices (e.g., cochlear implants, hearing aids) and habilitation with the intent to minimize delays in development.

Auditory Verbal Therapy (AVT) is a specialized habilitation intervention that focuses on improving listening skills while avoiding visual cues to communicate. The overall goal is to minimize the difference in speech and language capabilities between children with hearing loss and their peers without hearing loss. It requires certified professionals to deliver.

The effectiveness of AVT for children with hearing loss compared to other habilitation approaches remains unclear.

What Did We Do?

To inform decisions regarding the use of AVT, we summarized evidence that compared the effectiveness of AVT to alternative habilitation approaches for children with hearing loss using cochlear implants, bone conduction hearing devices, or conventional hearing aids. We also sought to identify evidence-based guidelines regarding appropriate habilitation approaches for this population.

We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2019. One reviewer screened articles for inclusion based on predefined criteria.

What did We Find?

For children with cochlear implants, AVT may result in better speech and language outcomes than standard habilitation, oral communication, total communication, or the bilingual-bicultural approach. However, AVT did not result in a significant difference in speech and language skills compared to sign and spoken language (1 systematic review).

AVT may result in better executive function compared to standard auditory training for children with cochlear implants (1 randomized controlled trial).

We did not find any evidence-based guidelines regarding appropriate habilitation approaches that met the predefined criteria for this rapid review. We also did not identify relevant evidence for children using bone conduction hearing devices and conventional hearing aids.

What Does it Mean?

Limited and low-quality evidence suggests that AVT is more effective than some alternative habilitation approaches for children using cochlear implants. High quality studies are needed with rigorous methodology, detailed reporting of results, and analysis controlling for confounding factors to make definitive conclusions about the performance of AVT against alternative habilitation for this population.

Although the literature comparing AVT to alternative approaches is limited, findings from before-and-after studies suggest that AVT improves speech, language, and executive function for children with cochlear implants. Decisions around the use of AVT may also depend on the individual needs and goals of the child and their parents or guardians and the resources needed to ensure capacity to deliver AVT, such as time and costs to certify professionals.  

Key Message

This rapid review updates the evidence for early biologic treatment versus conventional step-up therapy for patients with luminal Crohn disease, fistulizing Crohn disease, or ulcerative colitis.

Findings are based on 4 systematic reviews, 2 randomized controlled trials, and 3 updated clinical guidelines.

Luminal Crohn Disease

Three systematic reviews showed that early biologic treatment, initiated within 36 months of diagnosis, significantly improved clinical remission, mucosal healing, and reduced relapse rates, surgery needs, and disease progression compared to conventional strategies. Two randomized controlled trials found that early infliximab treatment led to better remission rates, quality of life, and safety outcomes compared with conventional treatment for both adults and children with newly diagnosed moderate-to-severe Crohn disease. These results are consistent with previous evidence suggesting that early biologic drugs improve clinical benefits compared with conventional strategies.

Clinical guidelines generally recommend biologic drugs as third-line treatment. One guideline targets adults and children with severe, active Crohn disease, and another focuses on children and adolescents with luminal Crohn disease regardless of severity. Of these, 1 guideline recommends first-line biologics for high-risk pediatric patients.

Fistulizing Crohn Disease

One guideline recommends third-line infliximab for patients with active fistulizing Crohn disease who did not respond, did not tolerate or had a contraindication to conventional therapy. First-line anti–tumour necrosis factor therapy was only recommended for children and adolescents with fistulizing perianal Crohn disease. No evidence was identified for this population.

Ulcerative Colitis

In 1 systematic review, early biologics were found to be associated with a higher risk of colectomy. However, these findings should be interpreted with caution as they are based on evidence from 3 observational studies. One guideline recommends infliximab as a third-line option for acute severe cases contraindicated to or clinically inappropriate with ciclosporin.