Andreea Dobrescu

MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and reference lists are commonly used when searching randomized controlled t

Clinicians and patients need updated information on antiviral treatments for COVID-19. To provide a final update on the benefits and harms of COVID-19 antiviral treatments in adult outpatients. Ovid/MEDLINE, Epistemonikos COVID-19 L·OVE platform, and iSearch COVID-19 portfolio (22 January 2025); Ovid/MEDLINE (24 September 2025). Two reviewers screened 20% of abstracts and full texts, then single screening. Randomized controlled trials were included for benefits and harms, and cohort studies were included for harms. One reviewer extracted data and assessed risk of bias and certainty of evidence (CoE); a second reviewer verified. Seven studies from the Omicron period were included. 125 mg of ensitrelvir may not reduce time to recovery and may result in no difference in serious adverse events (both low CoE) but may increase adverse events (44.2% vs. 24.8%; low CoE). Molnupiravir probably improves recovery (31.8% vs. 22.6%) and reduces time to recovery (9 vs. 15 median days) and persistent symptoms from 3 to 6 months (8.5% vs. 11.0%), with no effect on mortality, hospitalization, serious adverse events, and adverse events (all moderate CoE). Nirmatrelvir-ritonavir may increase recovery (70.7% vs. 53.6%; low CoE) and reduce time to recovery (no data, P = 0.011; low CoE) but probably increases adverse events (1.3% vs. 1.0%; moderate CoE). Simnotrelvir-ritonavir reduces time to recovery (-35.8 median hours; high CoE) and probably increases adverse events (28.9% vs. 21.6%; moderate CoE). There was no difference in recovery between molnupiravir and favipiravir (high CoE) and nirmatrelvir-ritonavir and molnupiravir (low CoE). Evidence for many outcomes is limited. Three COVID-19 antivirals improved or accelerated recovery, with varying adverse event profiles. Molnupiravir probably offers long-term benefits. American College of Physicians. (PROSPERO: CRD420251029146; OSF: https://osf.io/ywp6u).

Effective public health decision-making relies on rigorous evidence synthesis and transparent processes to facilitate its use. However, existing methods guidance has primarily been developed within clinical medicine and may not sufficiently address the complexities of public health, such as population-level considerations, multiple evidence streams, and time-sensitive decision-making. This work contributes to the European Centre for Disease Prevention and Control initiative on methods guidance development for evidence synthesis and evidence-based public health advice by systematically identifying and mapping guidance from health and health-related disciplines. Structured searches were conducted across multiple scientific databases and websites of key institutions, followed by screening and data coding. Of the 17,386 records identified, 247 documents were classified as ‘guidance products’ providing a set of principles or recommendations on the overall process of developing evidence synthesis and evidence-based advice. While many were classified as ‘generic’ in scope, a majority originated from clinical medicine and focused on systematic reviews of intervention effects. Only 41 documents explicitly addressed public health. Key gaps included approaches for rapid evidence synthesis and decision-making and methods for synthesising evidence from laboratory research, disease burden, and prevalence studies. The findings highlight a need for methodological development that aligns with the realities of public health practice, particularly in emergency contexts. This review provides a key repository for methodologists, researchers, and decision-makers in public health, as well as clinical medicine and health care in Europe and worldwide, supporting the evolution of more inclusive and adaptable approaches to public health evidence synthesis and decision-making.

Background: Peripherally inserted central catheters (PICCs) have a 29% complication rate. This systematic review evaluated 25 interventions to prevent PICC-associated infectious and noninfectious complications in participants of all ages. Methods: We searched electronic databases (MEDLINE, Embase, Cochrane Library, World Health Organization Global Index Medicus, CINAHL) and reference lists for randomized (RCTs) and nonrandomized controlled trials published between 1 January 1980-8 May 2024. We dually selected studies, assessed risk of bias, extracted data, and rated certainty of evidence (COE). We included single interventions of interest and combinations of at least 2 (bundle/multimodal). If 3 or more RCTs existed, we conducted Bayesian random-effects meta-analyses. Results: Seventy-four studies met our eligibility criteria (60 evaluated single interventions, 14 bundle/multimodal), addressing 13 of 25 research questions. The majority were conducted in high-income countries; 36 focused on neonates. Evidence was very uncertain for 11 of the 13 research questions. Stronger COE showed that ultrasound-guided catheter insertion reduced phlebitis/thrombophlebitis in adults compared with non–ultrasound-guided (5 RCTs; risk ratio [RR], 0.19; 95% credible interval, .08–.50); silicone catheters increased phlebitis/thrombophlebitis compared with nonsilicone (1 RCT; RR, 2.00; 95% confidence interval [CI], 1.26–3.17). Bundle interventions decreased local infections (1 RCT; RR, 0.47; 95% CI, .31–.72) and phlebitis/thrombophlebitis in adults (1 RCT; RR, 0.35; 95% CI, .22–.56) compared with routine care. Conclusions: Ultrasound-guided catheter insertion and nonsilicone catheters effectively prevented PICC complications. The evidence for other comparisons was too uncertain to draw conclusions, highlighting the urgent need for additional studies on prevention and control interventions.

Background: Peripheral intravenous catheters (PIVCs) contribute substantially to the global burden of infections. This systematic review assessed 24 infection prevention and control (IPC) interventions to prevent PIVC-associated infections and other complications. Methods: We searched Ovid MEDLINE, Embase, Cochrane Library, WHO Global Index Medicus, CINAHL, and reference lists for controlled studies from 1 January 1980–16 March 2023. We dually selected studies, assessed risk of bias, extracted data, and rated the certainty of evidence (COE). For outcomes with 3 or more trials, we conducted Bayesian random-effects meta-analyses. Results: 105 studies met our prespecified eligibility criteria, addressing 16 of the 24 research questions; no studies were identified for 8 research questions. Based on findings of low to high COE, wearing gloves reduced the risk of overall adverse events related to insertion compared with no gloves (1 non-randomized controlled trial [non-RCT]; adjusted risk ratio [RR], .52; 95% CI, .33–.85), and catheter removal based on defined schedules potentially resulted in a lower phlebitis/thrombophlebitis incidence (10 RCTs; RR, 0.74, 95% credible interval, .49–1.01) compared with clinically indicated removal in adults. In neonates, chlorhexidine reduced the phlebitis score compared with non–chlorhexidine-containing disinfection (1 RCT; 0.14 vs 0.68; P = .003). No statistically significant differences were found for other measures. Conclusions: Despite their frequent use and concern about PIVC-associated complications, this review underscores the urgent need for more high-quality studies on effective IPC methods regarding safe PIVC management. In the absence of valid evidence, adherence to standard precaution measures and documentation remain the most important principles to curb PIVC complications. Clinical Trials Registration: The protocol was registered in the Open Science Framework (https://osf.io/exdb4).