Use of red flags to screen for vertebral fractures in people with low back pain Key messages – The four best red flags for vertebral fractures in people with low back pain were corticosteroid use (e.g. medicines that can weaken bones), older age (e.g. aged above 70 years), trauma (e.g. a fall), and a contusion (bruising) or abrasion (cuts and grazes). – More research is needed to identify the best red flags or combination of red flags to screen for spinal fractures. Red flags to screen for spinal fractures Red flags for spinal fractures are signs and symptoms found by a health professional...

Psychological therapies for people with severe and enduring anorexia nervosa Key messages 1. One small study of people with severe and enduring anorexia nervosa compared two therapies: cognitive behaviour therapy and specialist supportive clinical management. 2. There is not enough evidence to say with certainty if any specific therapy is more effective than any other. 3. There is a need for larger studies to investigate the benefits of treatment for people with SEAN. Why is this review important? Anorexia nervosa is an eating disorder and serious mental illness. People with anorexia nervosa...

The impact of physical exercise on health-related quality of life in inflammatory bowel disease This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective: to determine the effect of structured physical activity and exercise therapy compared to placebo or normal physical activity on HRQOL of people with IBD (UC, CD, IBDU). Secondary objective: to evaluate the impact of these physical activity interventions on maintenance of remission and fatigue. This is a protocol....

Acupuncture for neonatal abstinence syndrome in newborn infants This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess if acupuncture reduces the treatment duration of neonatal abstinence syndrome (NAS) in newborn infants, reduces adverse events and reduces length of hospital stay. This is a protocol....

Mental Health First Aid as a tool for improving mental health and well-being Why was this review important? Mental health first aid is defined as 'the help provided to a person who is developing a mental health problem, experiencing a worsening of a mental health problem, or is in a mental health crisis' The first aid is given until appropriate professional help is received or the crisis resolves.' Mental Health First Aid (MHFA) is a training programme that aims to teach mental health first-aid strategies to members of the public. MHFA training works in a cascade model; accredited...

What are the benefits and risks of using topical insect repellents to prevent malaria? Key messages • Topical repellents may slightly reduce the incidence and prevalence of malaria caused by Plasmodium falciparum. • These changes seem to be particularly important in high-risk populations, specifically in refugees living in camps where there are fewer other options. • Topical repellents may make little or no difference in malaria prevalence and incidence in settings where insecticide-treated nets, and other options to control the transmission of malaria are readily available. What is malaria?...

Perioperative glucocorticoid stress dose for adult surgical patients at risk of adrenal insufficiency This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effect and harms of perioperative glucocorticoid stress dose for patients with known or suspected adrenal insufficiency for prevention of serious adverse events. This is a protocol....

Preferred treatment options for uncontrolled asthma in people on medium-dose inhaled corticosteroids Key messages • Adding a long-acting beta2-agonist (LABA) or a long-acting muscarinic antagonist (LAMA) to medium-dose inhaled corticosteroids (ICS) likely reduces asthma attacks requiring treatment with oral steroids and increases the odds of satisfactory symptom control compared to ICS alone, whereas doubling the dose of ICS probably does not. The amount of data we found was much larger for LABAs than for LAMAs. • We need to learn more about the long-term side effects of high-dose ICS...

Blue-light filtering spectacle lenses for visual performance, macular (back part of the eye) protection, and improving sleep quality What is the aim of this review? This Cochrane Review aimed to investigate the possible benefits and safety of blue-light filtering spectacle lenses, also known as blue-light blocking spectacle lenses, on visual performance, macular protection, and sleep quality. Cochrane Review authors collected and analysed all relevant studies to summarise the best available research evidence. Key message Blue-light filtering lenses may not reduce short-term eyestrain...

How effective are hydrogel dressings for helping donor site wounds to heal after split-thickness skin grafts? Key messages - We do not know if hydrogel dressings (designed to keep wounds moist) are better than other dressings for helping donor site wounds to heal after split-thickness skin grafts (skin taken from another part of the body). - We did not find any studies comparing hydrogel dressings with creams, ointments, or other solutions applied directly to the wound. - More and better designed studies are needed to answer this question. What are donor site wounds and split-thickness skin...

Prophylactic blood thinners for the prevention of death and venous thromboembolism in COVID-19 outpatients Key messages ‐ When used in the outpatient setting, anticoagulants (blood thinners) probably reduce venous thromboembolism (VTE) and pulmonary embolism (PE) when compared with placebo or no treatment in people with COVID-19. However, these drugs seem to have little or no effect in reducing death, major bleeding, need for hospitalisation, or adverse events. What is VTE? Venous thromboembolism, which includes both deep vein thrombosis (DVT) and PE, is a condition where a blood clot forms...

Consolidative thoracic radiotherapy for extensive disease small cell lung cancer This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness and safety of consolidative thoracic radiotherapy after chemotherapy in comparison with chemotherapy alone for ED SCLC. This is a protocol....

Medicines to manage pain and discomfort in premature babies assisted with breathing machines and at risk of brain bleeding Overview question Do pain medicines reduce brain bleeding and death and improve long-term development in babies born too early ('preterm' babies) who need mechanical breathing assistance? Background Preterm babies, especially babies born before 28 weeks of pregnancy are completed, sometimes develop brain bleeding. Babies with less severe bleeding may make a full recovery or have only mild problems later in life. Babies with more serious bleeding may die or have problems...

Interventions for the uptake of evidence-based recommendations in acute stroke settings Do implementation interventions improve the delivery of evidence-based care in acute stroke units? Key messages Implementation interventions are designed to improve the delivery of 'evidence-based' care, which is care that has been proven in research studies to help people with a particular health condition. We do not know if implementation interventions delivered in acute stroke units lead to better delivery of evidence-based care. More research is needed to investigate how to successfully implement...

What are the benefits and unwanted effects of topical anesthetics for corneal abrasions? Key message(s) 1. We are very uncertain about the effectiveness of anesthetic eye drops for control of pain due to corneal abrasions (scratches). 2. We are very uncertain about the safety of anesthetic eye drops regarding speed of healing and complications. 3. To ensure trustworthy evidence, researchers should follow best-practice guidance. Future research studies should include more people followed over a longer period of time after treatment ends. What is a corneal abrasion? A corneal abrasion is a...

Use of fibrin-based agents to reduce blood loss in adults undergoing liver surgery Key messages • The studies investigating fibrin-based agents for reducing blood loss in adult liver surgery have many design flaws, so their results are very uncertain. • Based on the available evidence, we cannot recommend or advise against the routine use of fibrin-based agents. What is topic of this review? People who undergo liver surgery for tumours are at risk of significant blood loss, complications after surgery, and even death. Several techniques have been developed to reduce blood loss in liver...

Is there a difference between pars plana vitrectomy with internal limiting membrane flap and pars plana vitrectomy with internal limiting membrane peeling for large macular holes? Key messages 1. Pars plana vitrectomy with internal limiting membrane flap technique compared to pars plana vitrectomy with internal limiting membrane peeling for treating macular holes may result in better vision after three or more months. 2. Pars plana vitrectomy with internal limiting membrane flap technique compared to pars plana vitrectomy with internal limiting membrane peeling for treating macular holes...

High flow nasal cannula oxygen therapy for respiratory support in term infants Review question Does high flow nasal cannula oxygen therapy improve the health outcomes of critically ill newborn infants requiring support for their breathing? Background When newborn infants have difficulty breathing, they may need external support to help move air in and out of their lungs (ventilation). There are various methods used to provide this breathing support. Invasive ventilation delivers air via a breathing tube placed in the baby's windpipe. Non-invasive ventilation delivers air via a mask that can...

Anti-vascular endothelial growth factor biosimilars for macular degeneration This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and safety of the anti-VEGF biosimilars compared with their reference product in people with neovascular AMD. This is a protocol....

What medicines are best for people with narrowing of the carotid arteries (blood vessels that deliver oxygen-rich blood from the heart to the brain)? Key messages Compared to placebo (an inactive medicine): - warfarin, an anticoagulant (blood-thinning medicine), may reduce the risk of side effects by 11%; - chlorthalidone, an antihypertensive (medicine for lowering high blood pressure), may slow the progression of carotid stenosis (narrowing of the carotid arteries) by 55%. Studies with more participants and with long-term follow-up are needed to define the best medical treatment for...