Is local or major surgery better for treating early rectal cancer with or without additional treatments before or after surgery? Key messages We are uncertain if local excision (LE) (removal through the anus of an early rectal cancer that has not grown beyond the muscle layer of the rectum, or stage I) may shorten the period of being cancer-free after surgery compared to radical resection (RR) (removing the entire rectum and its surrounding tissues through a major surgery). It is also unclear if LE affects cancer-related survival related compared with RR. There is probably a large reduction...

How successful are healthy eating programmes in preschools, kindergartens and childcare settings? Key messages • Healthy eating programmes delivered in early childhood education and care (ECEC) settings (e.g. preschools, kindergarten, family day care) may improve child diet quality, likely increase fruit consumption, may have favourable effects on vegetable consumption, and likely have no impact on consumption of less healthy foods and sugar-sweetened drinks. They may have favourable effects on child weight and may reduce the risk of being overweight or obese. • We don't know if healthy...

Antiviral drugs for prevention of hepatitis B virus mother-to-child transmission in pregnant women living with both human immunodeficiency virus and hepatitis B virus Review question Can antenatal (administered during pregnancy) antiviral combination drugs prevent transfer of hepatitis B virus from mother to baby in pregnant women suffering from both human immunodeficiency virus (HIV) and hepatitis B virus (HBV)? Key messages The evidence from five small randomised clinical trials showed neither beneficial nor harmful effects of tenofovir-containing antiviral combination drugs compared with...

Digital interventions for delivering exercise in people with Cystic Fibrosis Review question What are the benefits and risks of using digital interventions for delivering or monitoring, or both, physical activity in people with cystic fibrosis (CF)? Key messages Taken together, the results of these trials suggest the following. – Using a web-based application to record, monitor, and set goals on physical activity plus usual care may result in little to no difference on physical activity and pulmonary exacerbations (flare up of disease) compared to usual care alone. – The evidence is very...

What are the effects of policies that regulate how drugs can be marketed? Key messages Many countries have introduced policies to regulate how the pharmaceutical industry is allowed to market its products. However, we do not know what impact these policies have because there is a lack of well-conducted studies. What are drug marketing policies? It is very expensive to develop new drugs and bring them to the market. The pharmaceutical industry therefore uses a lot of resources to promote their drugs and increase their use. They often encourage patients and consumers to use these drugs, and...

What treatments reduce the need for a blood transfusion in adults who have broken their hip? Key messages - Using a medicine called tranexamic acid before, during, or after surgery for a broken hip probably reduces the need for a blood transfusion. - Treatment with iron may make little to no difference to whether people need a blood transfusion after they have broken their hip. What is the condition? A broken hip (a break at the top of the leg bone) is common in older adults whose bones may have weakened because of a condition called osteoporosis. People can lose large amounts of blood with...

Total and partial knee arthroplasty versus non-surgical interventions of the knee for moderate to severe osteoarthritis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of TKA and PKA for people with moderate to severe knee osteoarthritis compared to placebo or sham (efficacy) and to non-surgical interventions for the knee (comparative effectiveness). This is a protocol....

Exercise treatments for chronic low back pain: a network meta-analysis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The objectives of this systematic review, conducted using a collaborative review model, are to: Assess the effectiveness of exercise treatment (overall) in adults with chronic non-specific low back pain on important individual health outcomes: pain, functional limitations, health-related quality of life, depression, and adverse effects versus comparison treatments: (a) placebo, sham, or attention control, (b) no trial treatment...

Granulocyte colony-stimulating factor with or without stem or progenitor cell or growth factors infusion for people with compensated or decompensated advanced chronic liver disease Key messages In people with chronic liver disease with diffuse scarring (called cirrhosis) and impairment of liver function, the infusion of granulocyte colony-stimulating factor (G-CSF) may reduce the risk of death in comparison with standard treatment. Unexpected effects were either poorly reported, or the information was unclear. G-CSF is a protein that stimulates the growth and spread of undifferentiated cells...

Cannabis-based medicines for cancer pain Do medicines based on cannabis help adults with cancer pain? Key messages Cannabis-based medicines (CbMs) did not relieve cancer pain that did not respond to morphine-like medicines. The studies analysed did not allow any statement to be made on the place of these medications in the World Health Organization (WHO) analgesic ladder for cancer pain. Trials with CbMs in cancer need to be very much better designed than those conducted so far. Pain in cancer and its treatment One person in two or three who gets cancer will have pain that becomes moderate...

Interventions for motor rehabilitation in people with below-knee amputation due to peripheral arterial disease or diabetes Key messages – There is little research in the field of motor rehabilitation in people with amputation due to vascular causes. – The studies reported some positive results, but we have little confidence in the results due to small numbers of participants and limited data. What is amputation and what can happen after amputation? Amputation is the removal of an external part of the body. Amputations due to vascular causes are commonly associated with diabetes and...

Are medicines that aim to reduce blood loss during surgery effective in surgeries for trauma of the pelvis, hip, or long bones and do they cause unwanted effects? Key messages • We do not yet know the best medicines to reduce bleeding and blood transfusions during surgery for trauma of the pelvis, hip, or long bones (thigh-bones). • Some studies are still underway; when they have completed we will hopefully be able to make better conclusions. Background Fractures of the pelvis, hips and long bones can result in significant bleeding, with further blood loss if surgery is required to fix the...

How effective are the psychological interventions used for treating the consequences of sexual abuse in children and adolescents Key messages • A number of psychological therapies are used to help children and young people overcome the consequences of sexual abuse. • There is largely uncertain evidence to suggest that any particular interventions is better than management as usual in helping children and young people recover from sexual abuse. • We need more and better studies of interventions to establish whether one is better than another in addressing the various consequences of sexual...

What are the benefits and risks of magnetic seizure therapy for people with schizophrenia? Key messages There were too scarce data to evaluate the benefits and risks of magnetic seizure therapy (MST) for people with schizophrenia. We need more and better studies to look into this. What is schizophrenia? Schizophrenia is one of the most common and disabling mental disorders. People with schizophrenia may have difficulties living a normal life due to the illness, which may include distorted beliefs despite reality, hearing voices created by their minds, and having no interest in caring for...

What tools exist to assess the presence of multiple risk factors for dementia in middle-aged people, and can they correctly predict future dementia? Key messages • We found 14 tools used in middle-aged people to predict future dementia. • Seven studies tested a prediction tool named Cardiovascular Risk Factors, Ageing, and Dementia (CAIDE). • The benefits of using these tools to predict dementia later in life are unclear, because the studies provided little high-quality evidence. What is dementia? Dementia refers to a group of brain conditions that commonly affect older people and lead to...

Prebiotics for preventing necrotising enterocolitis in preterm infants Review question Does giving very preterm or very low birth weight infants prebiotics prevent necrotising enterocolitis? Background Very preterm (born more than eight weeks early) and very low birth weight (less than 1.5 kg) infants are at risk of developing necrotising enterocolitis, a severe condition where some lining of the infant's bowel becomes inflamed and dies. This condition is associated with death, serious infection, and long-term disability and developmental problems. One way to help prevent necrotising...

Do acetylcholinesterase inhibitors reduce the core impairments associated with autism spectrum disorder Key messages At present, it is unclear whether acetylcholinesterase inhibitors are effective in treating the core features of autism. This is because very few studies have been carried out. The two we found were small, and did not report the outcomes very well. However, there are a number of ongoing studies in this area. What is autism spectrum disorder? Autism spectrum disorder (autism) is a condition that affects the way a person thinks, feels, interacts with others, and experiences...

Does the number of doses of PEG-asparaginase affect survival and risk of toxicities? Review question How much asparaginase, a key drug in the treatment of the blood cancer acute lymphoblastic leukaemia (ALL), is optimal to ensure the best possible survival while minimising asparaginase-related toxicities? Background ALL is a subtype of blood cancer arising from malignant transformation of immature white blood cells of lymphoid origin. ALL is the commonest childhood cancer. Use of the anti-leukaemic medicine asparaginase has been of crucial importance for the advancement of the treatment of...

Multifaceted behavioral interventions to improve treatment adherence of glaucoma This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the impact of two or more behavioral interventions (i.e. multifaceted) on topical glaucoma therapy adherence in individuals utilizing intraocular-lowering therapy for at least three months prior to intervention for ocular hypertension or glaucoma. This is a protocol....

Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes Key messages - Quality improvement programmes can improve diabetes care, especially when multiple strategies are used in combination. - Strategies used in these programmes that lead to the largest improvements in key outcomes in people with diabetes are: case management, team changes, patient education and promotion of self-management. Why is improving diabetes care important? Diabetes, a disorder of how sugar is managed by the body, can lead to complications such as heart disease and...