Head impulse, nystagmus, and test of skew (HINTS) examination for causes in the brain of acute dizziness Key Messages The HINTS and HINTS Plus examinations were reasonably accurate for diagnosing a central cause for acute vestibular syndrome (AVS). What is acute vestibular syndrome? Acute vestibular syndrome is a specific type of dizziness, which can include severe vertigo (spinning sensation), nausea and vomiting, nystagmus (involuntary eye movements), or unsteadiness. Acute vestibular syndrome can be due to peripheral causes (those within the ear canal) or central causes (those within the...

Vaginal energy-based devices for vulvovaginal dryness This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of vaginal energy-based devices for women with vulvovaginal dryness related to genitourinary syndrome of menopause (GSM) or hormone therapy. This is a protocol....

What are the benefits and risks of methylxanthines (mild stimulant medicines) for premature babies whose breathing pauses during sleep (apnea)? Key messages - Compared to no treatment or a placebo (inactive) medicine, methylxanthines probably lead to fewer apnea episodes (pauses in breathing), probably reduce the need for breathing machines, and do reduce lung injury in preterm babies. - Methylxanthines probably make little or no difference to the risk of preterm babies dying before leaving hospital. There was little evidence about side effects of methylxanthines. - More research is needed...

What are the benefits and risks of using tests for lung maturation to assess if preterm newborns need to receive surfactant therapy to improve lung function? Key messages • Respiratory distress syndrome is a common condition in preterm infants, while the benefits of surfactant therapy guided by tests for lung maturation remain unclear. • No studies reported neonatal death (first 28 days of life) or neurodevelopmental outcome. It is uncertain whether surfactant therapy guided by tests for lung maturation has an effect on death prior to hospital discharge. Surfactant treatment guided by rapid...

What are the benefits and risks of tranexamic acid for percutaneous nephrolithotomy for the treatment of kidney stones? Key messages • Tranexamic acid, when compared to placebo (or no medication), may reduce blood transfusions, surgical complications, and a patient's hospital stay following percutaneous nephrolithotomy. • Tranexamic acid, when compared to placebo (or no medication), may improve the removal of stone material following percutaneous nephrolithotomy but may increase unwanted medication effects. • We do not know if tranexamic acid affects the risk of blood clots forming in other...

Endometrial injury in women attempting to conceive following sexual intercourse or intrauterine insemination: a collaborative individual participant data meta-analysis (IPD-MA) This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of endometrial injury for reproductive outcomes in women following sexual intercourse or intrauterine insemination compared to placebo or no intervention. This is a protocol....

What are the benefits and risks of stimulating medicines for breath-holding episodes in premature babies? Key messages – Due to a lack of robust evidence, the benefits and risks of doxapram (a medication used in cases when stimulation of breathing is necessary) in preventing or treating breathing pauses in premature babies are unclear. We found no data on long-term effects of the treatments. – Doxapram might be slightly better than no treatment in reducing breath-holding episodes with little or no difference in unwanted effects. Doxapram may be of little or no help in having the babies...

Effects of interventions targeting the systemic inflammatory response to cardiac surgery on clinical outcomes in adults Key messages - We are unsure of the benefits of anti-inflammatory interventions after cardiac surgery. - Further research should explore the role of factors such as age and chronic conditions on the response to anti-inflammatory interventions. What is the relation between inflammatory response and organ damage after cardiac surgery? Following cardiac surgery, different organs can be damaged, leading to serious complications, and sometimes death. We still do not clearly know...

Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries What is the main aim of this review? The aim of this Cochrane Review was to assess the effects of involving people in primary services and the community, such as nurses, midwives, teachers or caregivers, to promote mental health. The review focused on children and adults living in low- and middle-income countries. Key messages The employment use of primary-level and community workers may improve the mental health of adults and children...

Medication to treat fits in newborn babies Review questions What medication can be used effectively and safely to treat seizures in newborns? How long should the medication for seizures be continued once started? Should we treat seizures that are seen only on the EEG? Note: EEG is a test to analyse the electrical activity of the brain. It identifies seizure activity as well. Phenobarbital and levetiracetam are anti-seizure medications used in newborns. 'Maintenance treatment' refers to continuing the anti-seizure medication at a smaller dose, once seizures are stopped with a larger dose of...

What are the benefits and risks of different treatments for alopecia areata (hair loss)? Key messages -There are multiple treatment options for alopecia areata as systemic therapies such as immunosuppressants and local treatments such as hair growth stimulants, but it is unclear how helpful they are in producing new hair growth in the affected area. -Only one oral immunosuppressant treatment, baricitinib, showed an increment in hair regrowth. -Therapies appear to be safe and serious side effects are rare. -More good-quality studies are required to evaluate the therapies that appear to be...

Adenoidectomy for otitis media with effusion (OME or 'glue ear') in children Key messages We are uncertain whether surgery to remove the adenoids (adenoidectomy) improves hearing for children with glue ear, because the evidence is not robust. Adenoidectomy may slightly reduce the number of children who have glue ear after one to two years of follow-up, but we do not know the effect of this on hearing or quality of life. We know that there may be harms from surgery, such as a risk of bleeding. However, there was not enough information in the studies to know how often this may occur....

What are the risks and benefits of different positions for spinal taps in infants? Key messages • Spinal taps are often required in severe infections in newborns but may be difficult to perform, with approximately 50% of attempts ending in failure. • We identified studies comparing three different body positions during spinal tap: lying sideways (lateral decubitus), sitting, and lying on the stomach (prone). In all positions the infants should keep their legs tucked in and neck bent forward (flexed). • There may be little or no difference in first-time success rates between sitting and...

Prebiotics (dietary fibre), probiotics (good bacteria) or synbiotics (prebiotics plus probiotics) for people with chronic kidney disease Key messages Chronic kidney disease (CKD) is a serious health problem that affects over 850 million people worldwide. People with kidney disease have an unhealthy balance of good and bad bacteria in their guts, called 'gut dysbiosis'. This imbalance arises because of the effects of reduced kidney function (retained toxic waste products, fluid retention causing the gut wall to swell), drugs frequently used in people with CKD (especially antibiotics), and...

Evidence base for recommendations for writing evidence-based syntheses This is a protocol for a Cochrane Review (methodology). The objectives are as follows: To identify and assess studies of the effectiveness of interventions to create and implement recommendations for the writing of narrative summaries of evidence syntheses. We will do this separately for systematic reviews and CPGs. This is a protocol....

Antibiotics for otitis media with effusion (OME or 'glue ear') in children Key messages We are uncertain whether the use of antibiotics improves hearing for children with glue ear, due to a lack of robust evidence. The use of antibiotics compared to no treatment might slightly reduce the number of children who have glue ear at three months of follow-up. It is unclear whether this is a long-lasting effect, as few studies followed up children for more than three months. The studies included in this review did not report serious harms from treatment with antibiotics. However, there is...

Are higher or lower salt (sodium) supplements better for premature babies to prevent illness and improve growth and development? Key messages • During the first days after birth, premature babies need lower salt (sodium) intakes to prevent high blood sodium levels. However, we are uncertain if there are any effects on infant death or newborn health whilst in hospital. Growth and longer-term development were largely unreported in studies of early sodium supplementation. • After the first days following birth, premature babies need higher sodium intakes to prevent low blood sodium levels....

The impact of growth monitoring and promotion in children under five years of age in low- and middle-income countries What is growth monitoring and promotion? Many children under five years of age who live in low- and middle-income countries are not receiving adequate nutrition. This can lead to increased illnesses, impaired mental development (which diminishes school and work performance later in life) and death. Growth monitoring and promotion (GMP) is a complex intervention that involves measuring a child's growth at regular intervals and plotting the measurements on a chart, combined...

Which medications reduce irritability, aggression or self-harm in people with autism spectrum disorder (ASD)? Key messages • Only 3 classes of medications showed any reduction in irritability, aggression or self-harm when compared to placebo (a dummy medication). Atypical (second-generation) antipsychotic medications probably reduce irritability and aggression, but appear to have little to no effect on self-injury. Attention deficit hyperactivity disorder (ADHD)-related medications may reduce irritability, although the evidence is uncertain. Neurohormones (oxytocin and secretin) may also...

How can we communicate better with people and communities about measures which help to prevent and control COVID-19? Key messages - During a pandemic, governments and other authorities need to clearly communicate with the public about how people can keep themselves safe. This communication needs to be based on trust and well-planned. People and communities affected by the pandemic need to be involved in planning and delivering the communication. The communication should reach all people across the community, including those who have trouble reading and writing, people who speak languages...