Intrahepatic shunts in adults with kidney failure due to liver disease Review question Intrahepatic shunts compared with conventional treatment: which is best for improving the clinical conditions of adults with hepatorenal syndrome? Keys messages – We did not find enough good-quality evidence on the benefits and harms of intrahepatic shunts to improve clinical conditions in adults with hepatorenal syndrome. – Larger randomised clinical trials (trials where people are randomly put into one of two or more treatment groups) with more reliable data are needed to better assess the benefits and...

Medicine-free management of neonates' pain during endotracheal suctioning Key messages — Gently holding the infant in a flexed posture (facilitated tucking, which is the gentle positioning of an infant's arms and legs in a bent, midline position close to the infant's body while the infant is lying on their side, lying on their back with their face upwards (supine), or lying on their tummy with their head to one side (prone)) is probably effective in reducing pain during endotracheal suctioning in ventilated newborn infants What is endotracheal suctioning? An endotracheal tube is a...

Platelet transfusion thresholds for thrombocytopenic infants This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the safety and efficacy of more restrictive platelet transfusion thresholds compared to more liberal thresholds in thrombocytopenic neonates. This is a protocol....

Midline or off-midline wound closure techniques: which works better to treat pilonidal sinus disease? Key messages • Closing wounds from one side of the butt crack (off-midline closure) may lead to faster healing, lower chances of the disease returning, fewer infections, less chance of the wound breaking open again, shorter hospital stays, quicker return to work, and less pain compared to closing wounds directly from the middle of the butt crack (conventional midline closure). • We could not find enough good-quality evidence to show that off-midline closure is better than closing wounds from...

What is the best medication to stop bleeding in those having non-emergency hip or knee surgery? Key messages • Tranexamic acid may be an effective medicine to help blood to clot during hip or knee replacement surgery, which reduces bleeding and the need for a blood transfusion (replacing lost blood with donated blood). • A high dose of this medicine and administering it in more than one way (for example, as a tablet and injected into the joint at the end of surgery) appears to work best. • Tranexamic acid is potentially as effective when given as a tablet as when injected into a vein. •...

Granulopoiesis-stimulating factors to prevent adverse effects in the treatment of solid tumors This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy of prophylactic granulopoiesis-stimulating factors compared with placebo or no prophylaxis for improving survival and preventing adverse effects of cancer treatment in people with solid tumors. This is a protocol....

Does testosterone work in men who have problems with erections? Background Testosterone is a crucial male hormone. It is commonly used in men with low testosterone levels who experience erection difficulties. However, it is unclear how effective this treatment is and if it has unwanted harmful effects (adverse effects), especially on heart health. Key messages In the short term, testosterone replacement therapy has a minimal impact on erectile function, sexual quality of life, and cardiovascular mortality, with few side effects. The long-term effects of this therapy on erectile function...

Psychological treatment to help children and adolescents with asthma Key messages 1. The available evidence suggests that psychological interventions could be beneficial for children and adolescents with asthma. 2. Due to the differences between studies, it was very hard to compare the data, so the results of this review are very uncertain and difficult to interpret. Background Children and adolescents with asthma are more likely to experience symptoms of psychological distress (e.g. anxiety, depression, or both) than those without asthma. Psychological treatment might help reduce this...

Is alpha-lipoic acid (a natural antioxidant) better than no treatment or dummy treatment for nerve damage in people with diabetes? Key messages • We found that alpha-lipoic acid treatment compared with placebo (dummy treatment) probably has little or no effect on the symptoms of nerve damage and may have little or no effect on impairment after six months of treatment. • There is probably little or no difference between alpha-lipoic acid and placebo in the occurrence of unwanted effects that cause people to stop using treatment. • We found no studies to help us answer whether alpha-lipoic...

Oral killed cholera vaccines for preventing cholera Key messages Two doses of the whole-cell plus recombinant vaccine (WC-rBS vaccine (Dukoral)), with or without a booster dose, reduces cases of cholera for two years. Two doses of the bivalent whole-cell vaccine (BivWC vaccine (Shanchol)) reduces cases of cholera for five years. A single dose of Shanchol reduces cases of cholera and cases of severe dehydrating cholera for two years. The vaccines are considered safe, with similar side effects reported by all groups. Further studies are required to assess the effectiveness of a single-dose of...

Mindfulness-enhanced parenting programs for improving outcomes for children and their parents Key messages • Mindfulness-enhanced parent training programmes may improve some child and parent outcomes, including child emotional and behavioural adjustment, parenting skills, parental depression or anxiety, parenting stress, and parent mindfulness. • When mindfulness parent training is combined with a skills-based parent training programme, this may decrease parenting stress. • The current body of evidence is limited, with more research needed to be confident in our findings. Children's...

Interventions to encourage use of seat belts Key messages – We found some evidence to suggest education-based (behavioural and health risk appraisal (HRA)) and engineering-based interventions may promote seat belt use in early and late adolescents and adults; however, we are not confident in the current evidence. – More research is needed to better understand the effectiveness of education- and engineering-based interventions on seat belt use. – High-quality research is also needed to investigate the benefit of incentives (alone or combined with other interventions) as well as other types of...

Nutritional interventions for early psychosis: a systematic review and network meta-analysis This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To compare the efficacy of different kinds of nutritional supplements in individuals with early psychosis. This is a protocol....

Pharmacological interventions for bone health in people with epilepsy This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of various pharmacological interventions (for treatment and for prevention) for bone health in people with epilepsy. This is a protocol....

Retrograde distal vascular access versus femoral artery access for below the knee arterial angioplasty Key messages – The choice of vascular access can influence the outcome of below the knee angioplasty. – We identified no trials that compared retrograde distal access with femoral access for below the knee angioplasty for inclusion; there is a need for high-quality trials on this topic. What is peripheral artery disease? Peripheral artery disease is a stenosis (narrowing) or occlusion (blocking) of the limb arteries usually caused by the build-up of fatty deposits in the arteries (known as...

Vitamin B12 supplementation for women during pregnancy Key messages – Women who took vitamin B12 supplements during pregnancy may have improved vitamin B12 status during pregnancy or postpartum, including less vitamin B12 deficiency and higher vitamin B12 levels, compared to women who did not take vitamin B12 supplements, but the evidence is uncertain. – The effects of taking vitamin B12 supplements during pregnancy on other health outcomes in pregnant women or their children are not known. Public health implications Vitamin B12 is an important nutrient that helps keep your body's blood and...

Treatments to thin the blood during haemodialysis: which treatments reduce clotting problems without causing bleeding? What is the issue? When people have dialysis using a machine to clean their blood (called haemodialysis (HD)), blood-thinning treatment helps prevent blood clots in the dialysis tubing. However, thinning the blood too much with treatment can lead to bleeding problems. There are several different medications to thin the blood, but it is not clear which is the best or the safest choice. What did we do? We searched for all the research trials that assessed the blood thinning...

Pressure garments for preventing hypertrophic scarring after burn injury Key messages – We do not know if pressure garment therapy is more effective than other scar treatment options (e.g. silicone gel/sheets, massage with lanolin) for preventing an abnormally thick and raised scar (hypertrophic scarring). – Future studies should include more participants who are monitored for longer; should clearly report on any other treatments that are offered alongside or as an alternative to pressure garment therapy; and measure outcomes that are most important to people with burn injuries. What are...

Are population-based interventions (those aimed at entire communities rather than individuals) helpful in preventing falls and fall-related injuries in older people? Key messages: • We are unsure whether approaches to falls prevention that target the whole community reduce falls and fall-related injuries. • Future studies should be well-designed and use up-to-date descriptions of their interventions. Ideally, studies should be carried out in several communities (rather than just two study communities), each with large populations, and types of older people living in the study communities...

What are the benefits and harms of ibuprofen for managing pain after an operation in children? Key messages • Ibuprofen probably reduces pain intensity just after an operation up to two hours compared to a placebo (dummy) and compared to paracetamol. The evidence compared to other medicines and in the longer term is unclear or lacking. • Overall, we are uncertain about unwanted effects of ibuprofen, especially serious unwanted effects, since the studies in the review rarely measured them. • Future studies should examine ibuprofen compared to commonly used medications and measure benefits and...