Theresa A Lawrie

In the wake of the COVID-19 crisis, a need has arisen to prevent and treat two related conditions, COVID-19 vaccine injury and long COVID-19, both of which can trace at least part of their aetiology to the spike protein, which can cause harm through several mechanisms. One significant mechanism of harm is vascular, and it is mediated by the spike p...

Pharmacovigilance databases are showing evidence of injury in the context of the modified COVID-19 mRNA products. According to recent publications, adverse event reports linked to the mRNA COVID-19 injections largely point to the spike protein as an aetiological agent of adverse events, but we propose that the platform itself may be culpable. To as...

In the wake of the Covid-19 crisis, a need has arisen to prevent and treat two related conditions, Covid vaccine injury and long Covid, both of which have a significant vascular component. Therefore, the management of these conditions require the development of strategies to prevent or dissolve blood clots and restore circulatory health. This revie...

Rapid Response to BMJ Evidence-Based Medicine re Popp et al., Letter to Editor, DOI: 10.1136/bmjebm-2021-111791. Rapid Responses appear as tabs to the original Letter but do not acquire DOI references. This posting provides a DOI to the text of the Rapid Response and a clear text with errors of formatting in the journal version repaired.

A review of a recent Cochrane Review of ivermectin in Covid-19

Background The ECHO trial randomised 7829 women to depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD) and the levonorgestrel (LNG) implant (1:1:1) and found no clear difference in HIV incidence between these three groups. We have previously hypothesized that oligo-amenorrhoea induced by DMPA-IM may have a protective e...

Rapid Response submitted to BMJ Evidence-Based Medicine

Background: Repurposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with antiviral and anti-inflammatory properties, has now been tested in numerous clinical trials. Areas of uncertainty: We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemoprophylaxis...

Background Re-purposed medicines may have a role against the SARS-CoV-2 virus. The antiparasitic ivermectin, with anti-viral and anti-inflammatory properties, has now been tested in numerous clinical trials.Areas of uncertainty We assessed the efficacy of ivermectin treatment in reducing mortality, in secondary outcomes, and in chemo-prophylaxis, a...

Background Re-purposed medicines may have role in combating the SARS-CoV-2 virus. The antiparasitic medicine ivermectin, which has anti-viral and anti-inflammatory properties, has been tested in numerous clinical trials with promising results.Methods We assessed the efficacy of ivermectin treatment and/or prophylaxis among people with, or at high r...

Background Re-purposed medicines may have role in combating the SARS-CoV-2 virus. The antiparasitic medicine ivermectin, which has anti-viral and anti-inflammatory properties, has been tested in numerous clinical trials with promising results. Methods We assessed the efficacy of ivermectin treatment and/or prophylaxis among people with, or at high...

Objective To compare the effects of depot medroxyprogesterone acetate (DMPA‐IM), levonorgestrel (LNG) implant, and copper intrauterine device (IUD) on mood and sexual function. Methods At the Effective Care Research Unit in South Africa, women already randomized in the ECHO Trial to the three methods were asked to participate in this study. Partic...

This is the draft evidence to decision (EtD) framework on ivermectin to prevent and treat Covid-19 infection for the British online meeting of clinical experts and other stakeholders to be held on the 13th January 2021. The aim is to assess the evidence on effectiveness, resource use, equity, acceptability, and feasibility of using ivermectin for C...

This is version 1.2 of the ivermectin report dated 6 Jan 2021

This is a rapid review and meta-analysis of available comparative studies on ivermectin showing that ivermectin will probably substantially reduce the risk of death in people with COVID-19 and that it will probably substantially reduce the risk of COVID-19 infection among health care workers and contacts.

Supplementary data file.

Background: Glioblastoma (GBM) is a highly malignant brain tumour that almost inevitably progresses or recurs after first line standard of care. There is no consensus regarding the best treatment/s to offer people upon disease progression or recurrence. For the purposes of this review, progression and recurrence are considered as one entity. Object...

Background: Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedit...

Background The ECHO trial randomised 7829 women to depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD) and the levonorgestrel (LNG) implant (1:1:1) and found no clear difference in HIV incidence between these three groups. We have previously hypothesized that oligo-amenorrhoea induced by DMPA-IM may have a protective e...

Background: Increasingly, WHO recommendations are defined by context-specific factors and WHO is developing strategies to ensure that recommendations are successfully adapted and implemented at country level. This manuscript describes the development of a toolkit to support governments to adapt the WHO recommendations on antenatal care (ANC) for a...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:. To evaluate the effectiveness of further treatment/s for first and subsequent recurrence of glioblastoma multiforme (GBM) among people who have received the standard of care for primary treatment of the disease (chemoradiotherapy) or following development of GB...

Background: A glioblastoma is a fatal type of brain tumour for which the standard of care is maximum surgical resection followed by chemoradiotherapy, when possible. Age is an important consideration in this disease, as older age is associated with shorter survival and a higher risk of treatment-related toxicity. Objectives: To determine the mos...

( Int J Gynecol Obstet . 2019;146:56–64) Around 5% of women giving birth worldwide experience postpartum hemorrhage (PPH). PPH is defined as blood loss of ≥500 mL within a day of birth and most often occurs when the uterus does not contract following delivery. All women giving birth should be offered a uterotonic agent in the third stage of labor,...

Background: Clinical practice guidelines suggest that magnetic resonance imaging (MRI) of the brain should be performed at certain time points or intervals distant from diagnosis (interval or surveillance imaging) of cerebral glioma, to monitor or follow up the disease; it is not known, however, whether these imaging strategies lead to better outc...

( Lancet . 2019;393:330–339) Approximately 14% of maternal deaths worldwide are directly caused by hypertensive disorders of pregnancy, including preeclampsia. On the basis of surprisingly low rates of preeclampsia in low-income countries with high-calcium diets, it has been suggested that calcium deficiency may be linked to preeclampsia and severa...

Background: WHO has recognised the need to ensure that guideline processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. Along with decision-making criteria that require findings from effectiveness reviews, WHO is increasingly using evidence derived from qualitative evidence syntheses (QES)...

Background: This is the third in a series of three papers describing the use of qualitative evidence syntheses (QES) to inform the development of clinical and health systems guidelines. WHO has recognised the need to improve its guideline methodology to ensure that decision-making processes are transparent and evidence based, and that the resultin...

Background: WHO has recognised the need to improve its guideline methodology to ensure that guideline decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. To help achieve this, WHO guidelines now typically enhance intervention effectiveness data with evidence on a wider r...

Background: Gliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low aggressive potential in the short term, i.e. low-grade gliomas. Most people with low-grade gliomas are treated with surgery and may receive radiotherapy thereafter. However, there is con...

(Abstracted from Lancet 2019;393:330–339) Hypertension complicates 5% of all pregnancies and 11% of first pregnancies, and half of these cases are associated with preeclampsia (gestational hypertension plus proteinuria). Hypertensive disorders of pregnancy are the direct cause of death of approximately 30,000 women annually, or approximately 14% of...

Background Several uterotonic options exist for prevention of postpartum hemorrhage (PPH); hence, cost‐effectiveness is an important decision‐making criterion affecting uterotonic choice. Objective To conduct a systematic review of cost‐effectiveness of uterotonics for PPH prevention to support a WHO guideline update. Search strategy We searched...

Background: This is an updated merged review of two originally separate Cochrane reviews: one on robot-assisted surgery (RAS) for benign gynaecological disease, the other on RAS for gynaecological cancer. RAS is a relatively new innovation in laparoscopic surgery that enables the surgeon to conduct the operation from a computer console, situated a...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the most effective and best-tolerated approaches for the treatment of elderly people with newly diagnosed glioblastoma. To summarise current evidence for the incremental resource use, utilities, costs and cost-effectiveness associated with the diffe...

Background Reducing deaths from hypertensive disorders of pregnancy is a global priority. Low dietary calcium might account for the high prevalence of pre-eclampsia and eclampsia in low-income countries. Calcium supplementation in the second half of pregnancy is known to reduce the serious consequences of pre-eclampsia; however, the effect of calci...

Background: Cervical cancer is the fourth most common cancer in women, with 528,000 estimated new cases globally in 2012. A large majority (around 85%) of the disease burden occurs in low- and middle-income countries (LMICs), where it accounts for almost 12% of all female cancers. Treatment of stage IB2 cervical cancers, which sit between early an...

Background: Pre-eclampsia and eclampsia are common causes of serious morbidity and death. Calcium supplementation may reduce the risk of pre-eclampsia, and may help to prevent preterm birth. This is an update of a review last published in 2014. Objectives: To assess the effects of calcium supplementation during pregnancy on hypertensive disorder...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine whether interval brain imaging (performing brain imaging at regular intervals) compared with brain imaging upon clinical indication (performing brain imaging upon the development of new or worsening symptoms) improves outcomes associated with cerebr...

Background: This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the long-term neurocognitive and other side effects of radiotherapy (with or without chemotherapy) compared with no radiotherapy, or different types of radiotherapy, among people with glioma (where 'long-term' is defined as at least two years after d...

Globally, there is a shift in the maternal, newborn and child health agenda from an exclusive focus on survival to the inclusion of drivers for thriving and transformation. This shift is in line with the third Sustainable Development Goal – ensuring healthy lives and promoting well‐being for all at all ages – and the new Global Strategy for Women's...

Background: Several studies have identified how mistreatment during labour and childbirth can act as a barrier to the use of health facilities. Despite general agreement that respectful maternity care (RMC) is a fundamental human right, and an important component of quality intrapartum care that every pregnant woman should receive, the effectivene...

Background: An increasing number of people survive cancer but a significant proportion have gastrointestinal side effects as a result of radiotherapy (RT), which impairs their quality of life (QoL). Objectives: To determine which prophylactic interventions reduce the incidence, severity or both of adverse gastrointestinal effects among adults re...

Background: Extent of resection is considered to be a prognostic factor in neuro-oncology. Intraoperative imaging technologies are designed to help achieve this goal. It is not clear whether any of these sometimes very expensive tools (or their combination) should be recommended as standard care for people with brain tumours. We set out to determi...

Introduction This is the protocol for an ancillary study to the multicentre Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial, a three-arm randomised trial comparing the effects of depot medroxyprogesterone acetate (DMPA), the levonorgestrel (LNG) implant and the copper intrauterine device (IUD) on HIV incidence (NCT02550067 pre-resu...

Background The preconception period has the potential to influence pregnancy outcomes and randomized controlled trials (RCTs) are needed to evaluate a variety of potentially beneficial preconception interventions. However, RCTs commencing before pregnancy have significant participant recruitment and retention challenges. The Calcium And Pre-eclamps...

Background: This is an update of the original Cochrane Review published in Cochrane Library, Issue 10, 2012.Hydatidiform mole (HM), also called a molar pregnancy, is characterised by an overgrowth of foetal chorionic tissue within the uterus. HMs may be partial (PM) or complete (CM) depending on their gross appearance, histopathology and karyotype...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To establish the overall effectiveness and safety of intraoperative imaging in resection of glial tumours. © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

The 2016 WHO guideline on routine antenatal care (ANC) recommends several health systems interventions to improve quality of care and increase use of services including: Midwife-led continuity of care throughout the antenatal, intrapartum, and postnatal periods Task shifting components of ANC, including promotion of health-related behaviors and dis...

Background: Evidence from observational studies suggests an increased risk of HIV acquisition among women using depot medroxyprogesterone acetate (DMPA) contraception. Methods: Within the context of a South African programme to increase women's access to the intrauterine contraceptive device (IUD), we conducted a pragmatic, open-label, parallel-...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine which prophylactic interventions reduce the incidence, severity, or both of adverse gastrointestinal effects among adults receiving radiotherapy to treat primary pelvic cancers. © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

In 2015, an estimated 303 000 women died from pregnancy-related causes and 2.6 million babies were stillborn, half of which occurred during the third trimester (1, 2) Many of these adverse outcomes can be prevented by quality health care during pregnancy and childbirth. Within the continuum of care, antenatal care (ANC) provides a platform for crit...

Background: This is an updated version of the original review that was first published in the Cochrane Database of Systematic Reviews 2008, Issue 4. Laparoscopy has become an increasingly common approach to surgical staging of apparent early-stage ovarian tumours. This review was undertaken to assess the available evidence on the benefits and risk...

Background: This is an update of a review that was first published in 2002. Female sterilisation is the most popular contraceptive method worldwide. Several techniques exist for interrupting the patency of fallopian tubes, including cutting and tying the tubes, damaging the tube using electric current, applying clips or silicone rubber rings, and...

Clinical question: Which interventions are the most effective and tolerable for treating usual-type vulvar intraepithelial neoplasia? Bottom line: Provided cancer is not suspected, usual-type vulvar intraepithelial neoplasia treatment, including medical and surgical options, can be individualized to take into account the site, extent of disease,...

Background Depot medroxyprogesterone acetate (DMPA) is the most commonly used hormonal contraceptive method in South Africa. It is frequently administered in the immediate postnatal period, yet it is unclear whether it affects the risk of postnatal depression (PND). Aim To determine whether DMPA increases the risk of PND compared with the copper-c...

Background: This is the second update of a Cochrane review that was first published in 2009, Issue 1, . Gestational trophoblastic neoplasia (GTN) is a rare but curable disease arising in the fetal chorion during pregnancy. Most women with low-risk GTN will be cured by evacuation of the uterus with or without single-agent chemotherapy. However, che...

Background The copper intrauterine device (IUD) is under-utilised in South Africa, where injectable progestin contraception (IPC) dominates contraception usage. There is a lack of robust comparative data on these contraceptive options to inform policy, programs, clinical counseling, and women’s choices. Methods Within the context of a South African...

Background: Usual-type vulval intraepithelial neoplasia (uVIN) is a pre-cancerous condition of the vulval skin. Also known as high-grade VIN, VIN 2/3 or high-grade vulval squamous intraepithelial lesion (HSIL), uVIN is associated with high-risk subtype human papilloma virus (HPV) infection. The condition causes distressing vulval symptoms in the m...

Background: Fundal pressure (pushing on the upper part of the uterus in the direction of the birth canal) is often performed in routine practice, however the benefit and indications for its use are unclear and vigorous pressure is potentially harmful. There is some evidence that it may be applied routinely or to expedite delivery in some situation...

Background: This is an update of a review that was first published in 2002. Female sterilisation is the most popular contraceptive method worldwide. Several techniques exist for interrupting the patency of fallopian tubes, including cutting and tying the tubes, damaging the tube using electric current, applying clips or silicone rubber rings, and b...

This is the protocol for a review and there is no abstract. The objectives are as follows: To determine which interventions are the most effective, safe and tolerable for treating women with uVIN. The Methods section of this protocol is based on the Cochrane Gynaecological Cancer Group template:

Background: Routine use of caesarean section for breech presentation is widespread. However poor outcomes after breech birth may be the result of underlying conditions causing breech presentation rather than damage during delivery. Objectives: The objective of this review was to assess the effects of planned caesarean section for breech presenta...

Background: This is an update of a Cochrane review first published in 2012, Issue 4. Excessive weight gain during pregnancy is associated with poor maternal and neonatal outcomes including gestational diabetes, hypertension, caesarean section, macrosomia, and stillbirth. Diet or exercise interventions, or both, may reduce excessive gestational wei...