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ObjectiveThe Clinical Dementia Rating (CDR) Scale comprising global score (CDR‐GS) and sum of boxes scores (CDR‐SB) is commonly used in staging cognitive impairment; however, its diagnostic accuracy is not well clarified. The meta‐analysis aimed to investigate the diagnostic accuracy of the CDR for mild cognitive impairment (MCI) and dementia in older populations.MethodsStudies examining the diagnostic accuracy of the CDR for MCI or dementia against reference standards were included from seven electronic databases. The bivariate analysis with a random‐effects model was adopted to calculate the pooled sensitivity and specificity of the CDR for MCI and dementia.ResultsFifteen studies investigating the diagnostic accuracy of the CDR‐GS (n = 13) or CDR‐SB (n = 5) for MCI or dementia were included. The pooled sensitivity and specificity of the CDR‐GS for MCI were 93% and 97%, respectively. With respect to dementia, the CDR‐GS had superior pooled specificity compared to the CDR‐SB (99% vs. 94%), while similar sensitivities were found between the CDR‐GS and CDR‐SB (both 87%). Significant moderators of an old age, a high educational level, a high prevalence of MCI or dementia, being in a developing country, and a lack of informants' observations may affect the estimation of the sensitivity or specificity of the CDR.ConclusionsEvidence supports the CDR being useful for detecting MCI and dementia; applying the CDR for staging cognitive impairment in at risk populations should be considered. Furthermore, including objective observations from relevant informants or proxies to increase the accuracy of the CDR for dementia is suggested.

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Background High rates of early initiation and exclusive breastfeeding have been reported in Malawi, yet the underlying factors are unknown. Our objective is to examine the determinants of breastfeeding practices for mothers of infants less than 24 months old in Malawi. Methods A cross-sectional study was conducted using nationally representative data from the 2010 Malawi Demographic and Health Survey. Multivariate logistic regression analysis was used. Results Of 7282 women, 95.4% initiated breastfeeding within 1 hour after birth; thereafter 71.3% of women practiced exclusive breastfeeding, 6.1% predominantly breastfed, and 1.9% chose bottle feeding exclusively. The odds of early initiation were higher among women with frequent antenatal care visits and multiparous mothers. Similarly, frequent antenatal care visits and hospital delivery were positive determinants for exclusive breastfeeding. Infants at 6 months of age were more likely to predominantly breastfeed than they were at 1 month. The odds of bottle feeding were higher among women who were educated, who delivered at a hospital. Conclusions Optimal breastfeeding practices are highly prevalent in Malawi. Health care practice emphasizing frequent antenatal care visits that provide breastfeeding education and breastfeeding support in hospital care after childbirth are important for sustaining breastfeeding.

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Study Objectives To compare the efficacy and safety of various hypnotics for identifying the best treatments for insomnia in older adults. Methods We searched the EMBASE, PubMed, ClinicalTrials.gov, and ProQuest Dissertations and Theses A&I databases from the inception to September 12, 2020. Only randomized controlled trials comparing hypnotics with either another hypnotic or placebo for insomnia treatment in elderly people were included. Sleep outcomes, including total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, were derived from polysomnography, valid questionnaires, or sleep diaries. Results We identified 24 articles with 5,917 older adults. Eszopiclone and low-dose doxepin were ranked the optimal therapy for prolonging objective and subjective total sleep time (26·69 and 28·19mins), respectively, compared to placebo. Zaleplon was the most effective therapy in reducing objective and subjective sleep onset latency (-21·63 mins and -15·86 mins) compared with control. Temazepam was the best treatment for objective and subjective wake after sleep onset (-25·29 mins and -22·25 mins) compared with control. Low-dose doxepin appeared to be the effective treatment for increasing objective sleep efficiency (6.08%) Triazolam showed the higher risk of overall adverse events (odd ratio, 1·96, 95% confidence interval 1·03 to 3·74) when compared to zaleplon. Conclusions Considering study quality and the potential adverse effects of benzodiazepines and nonbenzodiazepines, low-dose doxepin seems to be the optimal pharmacotherapy for the improvements of total sleep time and sleep efficiency. Future randomized controlled trials investigating the treatment effects of hypnotics, particularly low-dose doxepin, on insomnia in older adults are warranted. PROSPERO Registration number CRD42016046301

Aim: This study aimed to assess the effects of daily sedation interruption on the mechanical ventilation duration and relevant outcomes in mechanically ventilated patients in the intensive care unit (ICU).Background: Previously, three meta-analyses on the association of daily sedation interruption with the mechanical ventilation duration have reported conflicting findings, and these did not support current guideline recommendations that daily sedation interruption can be routinely used in mechanically ventilated adult ICU patients.Design: This was a systematic review and meta-analysis of randomized controlled studies.