How accurate are the FIB-4 score and Forns index (non-invasive tests) in diagnosing liver fibrosis (scarring) stages in adults with chronic hepatitis C? Key messages • Both the FIB-4 score and Forns index can be used in the initial phase of investigating whether someone has liver scarring. • It is best to use the FIB-4 score to rule out stage 3 (severe fibrosis) or stage 4 scarring (cirrhosis). • It is best to use the Forns index to diagnose people with stage 2 scarring (significant fibrosis). Why is improving the diagnosis of liver scarring important? Hepatitis C infection is a common cause...

Deep brain stimulation for Tourette's syndrome This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and harm of deep brain stimulation for motor symptoms, with psychiatric and behavioural comorbidities, either individually or in combination, in adults and adolescents with Tourette's syndrome compared to placebo, sham intervention, or the best available behavioural and pharmacological treatment. This is a protocol....

Is immunotherapy plus chemotherapy better than chemotherapy alone for older people with non-small cell lung cancer? Key messages • For people 65 years and older with advanced non-small cell lung cancer (NSCLC) who have not previously been treated for cancer, adding immunotherapy to chemotherapy prolongs life and extends the time before their cancer progresses. This finding comes from studies that mainly included people between 65 and 75 years old. • We did not find these same beneficial effects of adding immunotherapy to chemotherapy in people over 75 years old. What is advanced non-small...

What are the benefits and harms of tamoxifen for treating people with hepatocellular carcinoma? Key messages We are not sure whether tamoxifen benefits survival, disease progression (disease getting worse), or well-being in people with advanced hepatocellular carcinoma (the most common type of liver cancer) when compared with no active treatment, supportive treatment (to relieve symptoms), or a dummy pill. We are not sure whether tamoxifen changes how often serious and non-serious unwanted effects occur in people with advanced hepatocellular carcinoma (where the cancer has spread) when...

Are education and psychological therapies effective for managing eczema? Key messages • Face-to-face education for individuals and groups may reduce eczema severity. Using technology to deliver education, such as the internet, may have little or no effect on disease severity. • Using nurse practitioners instead of dermatologists to deliver group education may have lower costs and be similarly effective. • People's circumstances vary and this will affect delivery of, and and how they receive information. Educational and psychological interventions for people with eczema should be developed...

Is transarterial (chemo)embolisation better than systemic chemotherapy for treating bowel cancer that has spread to the liver? Key messages – Transarterial chemoembolisation (abbreviated as TACE) is a method of destroying cancer cells by giving anticancer medicines and tiny beads that block the blood supply to the tumour directly or giving beads that are coated with anticancer medication. TACE may reduce deaths compared with an anticancer medicine that is given by injection into a blood vessel travelling to cells all over the body (called systemic chemotherapy), but the evidence is very...

Alcohol consumption and heart failure: a dose-response meta-analysis This is a protocol for a Cochrane Review (prototype). The objectives are as follows: Main objective To assess the effects of alcohol consumption on the progression to symptomatic (stage C) heart failure in people at risk for heart failure (stage A) or in people with pre-heart failure (stage B). Secondary objectives To assess the effects of alcohol consumption on progression of left ventricular dysfunction in people with stage A or stage B heart failure. We will assess the effect of alcohol consumption on the development of...

Surgery for normal pressure hydrocephalus of unknown cause Key messages - Surgery to move excessive fluid away from the brain (cerebrospinal fluid (CSF)-shunting) likely improves walking speed and disability in the short term (less than six months post-surgery) in people with idiopathic normal pressure hydrocephalus (iNPH). - CSF-shunting did not cause any deaths, and repeat surgery was rare, but unwanted effects were common in the studies assessed. - More evidence on the effect of CSF-shunting on quality of life is needed. What is idiopathic normal pressure hydrocephalus? Normal pressure...

Comparing skin treatments for eczema Key messages: ° Strong corticosteroids, JAK inhibitors and tacrolimus 0.1% (all drugs that suppress the immune system) are consistently effective at reducing signs and symptoms of eczema. ° Unwanted effects, such as burning and stinging, are more likely with tacrolimus, pimecrolimus and crisaborole and less likely with corticosteroids; other unwanted effects, such as skin thinning, are only likely when strong corticosteroids are used long term. ° Given uncertainty about long-term effectiveness and safety, other factors such as availability, cost and...

How accurate are routine laboratory tests in predicting mortality and deterioration to severe or critical COVID-19 in people with SARS-CoV-2? What are routine laboratory tests? Routine laboratory tests are a set of commonly performed blood tests that provide information about a patient's health status. These tests can be used to identify disease or monitor health. What did we want to find out? It is important to identify patients, presenting at a doctor's appointment at an outpatient service or at the emergency department who are at high risk of developing severe COVID-19 disease or dying....

Is repetitive transcranial magnetic stimulation (rTMS) an effective and safe treatment for adults with post-traumatic stress disorder (PTSD)? Key messages • rTMS probably does not reduce the severity of PTSD symptoms by the end of treatment compared with placebo rTMS (sham stimulation) in adults. These findings, however, were limited by wide variations in how the treatment was delivered and the small number of participants. • Occurrences of serious unwanted effects in studies of rTMS for PTSD have been rare. • We need more studies investigating rTMS for PTSD in adults. It would be helpful if...

Cenobamate as an add-on treatment for focal epilepsy that does not respond to other long-term antiseizure medication Key messages - When added to one or more antiseizure medications, cenobamate is probably better than placebo (sham medical treatment) in reducing the frequency of epileptic seizures by at least 50% and in achieving seizure freedom in adults with focal epilepsy who do not respond to long-term antiseizure medications. - Cenobamate use probably causes more unwanted effects than placebo. What was studied in this review? Epilepsy is a disease of the brain where there is a...

Overall prognosis of index lung cancer recurrence or of second primary lung cancer in people with non-small cell lung cancer operated with complete resection This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: We aim to compare overall survival in people with recurrence and second primary lung cancer (SPLC) after lung cancer surgery. If survival differs between those people categorised as having index lung cancer recurrence and those categorised as having SPLC, it might be possible to identify the definition that has the best discriminatory capacity from the...

Are services organised to deliver care for people with atrial fibrillation (irregular heartbeat) better than usual (routine) care? Key messages • Organised care services for atrial fibrillation (AF) probably cause a large reduction in death from all causes and do reduce heart-related hospital admissions, but they probably make little to no difference to hospital admissions from all causes and may not reduce heart-related death compared with routine care (care provided as part of normal practice). • Organised care services for AF may not reduce complications such as stroke and mini-stroke and...

Minimally invasive versus open pancreatoduodenectomy in benign, premalignant, and malignant disease. This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of laparoscopic or robot-assisted pancreatoduodenectomy versus open pancreatoduodenectomy for people with benign, premalignant, and malignant disease. This is a protocol....

Are surgical interventions better than no treatment or non-surgical interventions for treating hallux valgus (bunions)? Key messages – Surgery may result in an improvement in pain, and a slight improvement in function and satisfaction with treatment compared with no treatment or non-surgical treatment. However, complications of surgery, such as wound infection, or hardware irritation requiring additional surgery, need to be balanced against its benefits in pain and function improvement. What is hallux valgus? Hallux valgus is a bony lump that forms on the inside of the feet (known as...

When is the best time to stop giving caffeine to newborns born preterm? Key messages • Currently, we do not know when to stop giving caffeine to preterm babies. • If we stop the caffeine too early, babies may have brief, sometimes repetitive, episodes when they have lower levels of oxygen in their blood. • We need to do more studies to find out the best time to stop giving caffeine to preterm babies. Why is caffeine given to premature babies? Caffeine is a stimulant used to prevent and treat apnea – when breathing repeatedly stops and starts – in preterm infants. Caffeine also seems to...

Exercises for the prevention of non-specific low back pain This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effects of exercise alone or exercise plus education compared with inactive control or education alone to prevent non-specific LBP. This is a protocol....

Eye movement desensitisation and reprocessing for survivors of life-threatening medical events This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of eye movement desensitisation and reprocessing (EMDR), a psychological intervention programme, on symptoms related to traumatic stress in survivors of life-threatening medical events. Secondary objectives: to evaluate whether the effects of EMDR differ according to the nature of the medical event (associated diagnosis or setting), measured outcome (post-traumatic stress disorder (PTSD),...

Robot-assisted versus conventional laparoscopic surgery for rectal cancer This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of robot-assisted surgery for rectal cancer resection. This is a protocol....