Invasive management for patent ductus arteriosus in preterm infants This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective: to assess the effectiveness and safety of invasive PDA closure strategies in preterm infants compared to medical management (pharmacotherapy or conservative) or no treatment. Secondary objective: to analyse subgroups based on the following. Postnatal age at intervention (less than four weeks versus late rescue) Initial mode of treatment versus after failed medical management (based on courses and timing of...

Hyaluronic acid for chronic wound healing What is the aim of this review? The aim of this review was to evaluate the effects of hyaluronic acid on the healing of chronic wounds. Hyaluronic acid is a naturally occurring molecule present in human cells. Chronic wounds are wounds that take a long time to heal. They include pressure ulcers, foot ulcers, and leg ulcers. Key messages We cannot be certain whether dressings and topical agents containing hyaluronic acid are more effective for healing pressure ulcers or foot ulcers in people with diabetes than other dressings and topical agents. When...

What is the evidence that 'microclots' cause the post-COVID-19 syndrome, and is removal using plasmapheresis justified? Key messages 1. The term 'microclots' is not the correct term for the particles being investigated in people with post-COVID-19 syndrome, as they are not clots. The term 'amyloid fibrin(ogen) particles' is more appropriate. 2. The evidence shows that amyloid fibrin(ogen) particles are found in healthy people and those with other diseases, so they are not unique to post-COVID-19 condition. 3. Patients should not receive plasmapheresis for this indication outside...

Cognitive behavioural therapy plus standard care versus standard care for persistent aggressive behaviour or agitation in people with schizophrenia Is cognitive behavioural therapy better than conventional treatment for treating aggression or agitation in people with schizophrenia? Key messages • We did not find enough good-quality evidence about the benefits of cognitive behavioural therapy on aggression in people with schizophrenia. We found only two studies with not enough participants enroled to give reliable results. • Larger, well-designed studies are needed to give better estimates of...

Are antiplatelets an effective treatment for people with COVID-19? Key messages Antiplatelets are a group of different medicines that can prevent potentially fatal clot formation in the blood vessels ('thrombotic events'). For hospitalised patients with COVID-19, they probably slightly reduce thrombotic events but probably do not affect deaths, clinical worsening or improvement in COVID-19 compared with placebo or standard care. However, antiplatelets may result in a slight increase in serious unwanted effects ('adverse events') and probably increase major bleeding. Similarly, in...

Cognitive behavioural therapy for adults with overweight or obesity This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of cognitive behavioural therapy for weight management in adults with overweight or obesity. This is a protocol....

Healthcare workers’ informal uses of mobile devices to support their work: a qualitative evidence synthesis This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To explore the views, experiences, and practices of healthcare workers, managers and other professionals working in healthcare services regarding their informal, innovative uses of mobile devices to support their work. This is a protocol....

Does follow-up with ultrasound after lower limb arterial vascular surgery improve limb salvage rate and maintenance of the open artery? Key messages Due to the lack of strong evidence, the benefits of intensive surveillance with duplex ultrasound (DUS) after lower limb revascularisation are unclear. No study reported on adverse events relating to DUS surveillance. What are the benefits of DUS surveillance? The obstruction or narrowing of the large arteries of the lower limbs, known as lower extremity atherosclerotic disease or peripheral arterial disease, may require revascularisation...

Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis Key messages The prevention and treatment of hepatic encephalopathy, in people with cirrhosis, largely depends on use of the compound lactulose. Rifaximin is not used to treat hepatic encephalopathy, at present, but it is used as an add-on to lactulose to help prevent hepatic encephalopathy in people whose response to lactulose is inadequate. We found that combining rifaximin with lactulose improved hepatic encephalopathy, reduced the risk of dying, and reduced the risk of developing side effects in...

Is the use of a constricting device (tourniquet) during amputation safe and effective in reducing complications? Background Each year, millions of people worldwide are affected by blockages of their arteries that require amputations. A large volume of blood can be lost during this surgery, which can lead to complications including death. Treating patients with blood transfusions has risks. Tourniquets are devices that squeeze the leg above where it is due to be amputated, and can be used during amputation to reduce blood loss and the need for blood transfusions. Although they are considered...

Which strategies might influence how accurately and how long people with cystic fibrosis complete chest physiotherapy and exercise? Background Cystic fibrosis (CF) is a progressive and life-limiting genetic condition that affects many systems in the body, especially the lungs. In the UK, 1 in every 2500 babies is diagnosed with CF. Physiotherapy is a very important part of treatment for people with CF. The two main goals of chest physiotherapy are to clear sticky mucus from the airways to prevent repeated infections and lung damage and to maintain physical fitness through exercise. Chest...

Continuous positive airway pressure for apnoea of prematurity Key messages We did not find any study that compared CPAP with supportive care for apnoea of prematurity. We found four studies comparing one type of CPAP to another. The studies were small and the care given by healthcare workers may have been influenced by knowing which treatment the baby was receiving. Therefore, we don’t know from these studies whether there is any difference between different types of CPAP for reducing apnoea in babies born too early. What is apnoea of prematurity? Babies born early (preterm) may experience...

Vedolizumab for induction and maintenance of remission in Crohn's disease Key messages – Vedolizumab is effective in inducing and maintaining remission in people with Crohn's disease when compared to placebo (a dummy treatment). – People receiving vedolizumab are probably no more likely than people receiving placebo to experience side effects, and may be no more likely to experience serious side effects, during induction or maintenance treatment. What did we want to find out? Crohn's disease is a chronic inflammatory condition affects the gastrointestinal tract (the gut). Vedolizumab is...

Non-surgical therapy for Peyronie's disease Review question In men with Peyronie's disease, how do treatments that are not surgery, such as pills, creams, injections, or treatments using shock waves, affect men's reported sexual function? Background Peyronie's disease may cause penile curvature, pain, or both, which makes it difficult to perform penetrative intercourse. Aside from surgery, many other treatments may or may not help with this disease, but it is unclear how well they work. Methods We used the recommended Cochrane methods, including GRADE to rate the certainty of the...

Early versus late urethral catheter removal after kidney transplantation What is the issue? The ureter is a pipe that drains urine from the kidney into the bladder, where it is stored until patients go to the bathroom to pass urine. During a kidney transplant operation, the new kidney is placed inside the patient, and the new ureter is attached to the patient's bladder. During this procedure, a catheter is inserted through the urethra into the bladder and left in place following the operation. A catheter is a narrow flexible tube that allows urine to drain from the bladder. The catheter...

What are the benefits and harms of diuretics given as a first treatment compared to other drug classes for hypertension (high blood pressure)? Key messages: - Thiazides and thiazide-like drugs (diuretics) probably decrease some adverse cardiovascular events compared to beta-blockers, calcium channel blockers, ACE inhibitors, and alpha-blockers when used as the first-line drug for the treatment of hypertension. - Total mortality is probably not different between diuretics and the other drug classes. - First-line diuretics likely reduce total cardiovascular events and heart failure compared to...

How effective are physical activity and education for chronic musculoskeletal pain in children and adolescents? Key messages - We are uncertain whether physical activity reduces pain or improves disability compared with usual care. We did not find studies that compared physical activities with medical care intervention (e.g. education). - We did not find studies that evaluated education about physical activity, with or without physical activity, in children and adolescents. - Due to the small number of included studies, and the ways in which the studies were conducted, which could introduce...

Interventions for people with type 2 diabetes mellitus fasting during Ramadan Review question What are the effects of interventions for adults with type 2 diabetes who fast during Ramadan? Background Fasting during Ramadan is one of the pillars of Islam's core beliefs and practices. During this period, all healthy Muslim adults will fast from dawn to dusk (sunset) and take meals after sunset or Iftar. People who are ill or have medical conditions such as type 2 diabetes are exempted from fasting. However, many individuals with type 2 diabetes choose to fast during Ramadan, which can have a...

Does oestrogen therapy help to treat pelvic organ prolapse in postmenopausal women? Key messages • Although 14 studies met the inclusion criteria for this review, no studies addressed our comparisons of greatest interest, so we are uncertain about the effects of oestrogen therapy on pelvic organ prolapse in postmenopausal women. • Further research is needed to assess the effects of oestrogen therapy, alone or in combination with other treatments, on pelvic organ prolapse in postmenopausal women. What is pelvic organ prolapse? Pelvic organ prolapse is when a woman's uterus (womb), bladder, or...

Emergency department or acute assessment unit: which is able to see and treat patients faster? Key messages • Emergency departments see and treat people with urgent illnesses or injuries. Worldwide, emergency departments are experiencing challenges in delivering care to patients because of increasing numbers of people needing to use them. • Acute assessment services are an alternative place for some patients to be seen and treated instead of the emergency departments and may help to ease long waiting times in the emergency departments. • It is unclear how safe and effective acute assessment...