In women who have had one or both breasts removed, which breast reconstruction technique leads to better quality of life: use of implants or use of the woman's own tissue? Key messages • Breast reconstruction surgery that uses autologous tissue (the woman's own tissue, like fat or muscle) rather than implants might lead to better mental and sexual well-being and greater satisfaction with the operation overall. The rest of the evidence is very uncertain; it suggests autologous reconstruction compared with implants may improve women's satisfaction with the look and feel of the breast and...

How accurate are toe-brachial index and toe systolic blood pressures for peripheral arterial disease? Key messages - There is currently a lack of quality evidence to support the use of toe-brachial index (TBI) and toe systolic blood pressure (TSBP) to detect peripheral arterial disease, and clinicians should interpret these tests with caution. - More high-quality studies with larger numbers of participants are required to increase the certainty of evidence. Why is improving the diagnosis of peripheral arterial disease important? Peripheral arterial disease affects approximately 236 million...

First-line therapy for high-risk people with chronic lymphocytic leukemia: a network meta-analysis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective: to assess the benefits and harms of currently recommended regimens as the first-line therapy in high-risk people with chronic lymphocytic leukemia, using network meta-analysis Secondary objectives: to assess whether the benefits and harms of the recommended regimens differ according to sex, Rai stage, or genetic mutation status to estimate the ranking of treatments for overall survival,...

Pharmacological interventions for peripartum cardiomyopathy This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness and safety of available pharmacological interventions for the care of women diagnosed with PPCM. This is a protocol....

Improving healthcare professionals' reporting of adverse drug reactions and medication errors Key messages - Healthcare professionals have a responsibility to report unexpected and harmful responses to medicines. These responses are known as 'adverse drug events', a term that includes both adverse drug reactions (ADRs) and medication errors (MEs). - An education session (outreach, in-person workshops or via telephone), along with providing a reminder card and ADR report form, may substantially increase the number of ADR reports submitted. - Using a standardised discharge form with...

What are the benefits and risks of medications for retained placenta after vaginal delivery? Key messages Uterotonics (medications used to cause contractions of the womb) may be no more effective than placebo (pretend treatment) or no treatment in avoiding manual removal of the placenta (removal of the placenta by inserting a hand into the womb), and probably do not reduce severe bleeding or need for a blood transfusion (where blood is taken from a donor and injected into the person who has lost a lot of blood). Different types of these medications probably make little to no difference in...

What are the benefits and risks of different perineal techniques during the second stage of labour for preventing post-birth injury? Key messages Evidence on the effect of perineal techniques to prevent post-birth injury and blood loss is very uncertain due to poor study quality and small studies. Further large, well-conducted studies are needed and should measure post-birth haemorrhage, adverse effects and maternal satisfaction. What is post-birth injury? Post-birth injury can occur in the perineal area (the area between the vulva and anus) during active labour. Women with post-birth injury...

Topical, light-based, and complementary interventions: which works better to treat acne and its complications? Key messages • We did not find enough good-quality evidence about benzoyl peroxide, topical antibiotics, and topical retinoids for treating acne. We found that the included systematic reviews only provided a small amount of evidence on these clinically important drugs for us to summarise. • Future research should focus on areas that are important to patients, researchers, and decision-makers, such as new drugs for acne treatment, topical antibiotics and retinoids, and acne...

Risk of fracture in users of hormonal contraception This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of hormonal contraception used for pregnancy prevention on fracture risk in individuals who are currently or were previously capable of becoming pregnant. This is a protocol....

Is artificial intelligence (AI) better than humans for diagnosing the eye condition 'exudative age-related macular degeneration'? Key messages • Compared to human experts, artificial intelligence (AI)-based tests may be comparably accurate at detecting the exudative (or wet) form of age-related macular degeneration (eAMD). • There were no significant differences in the performance regardless of the other eye conditions in the image dataset or the image types used. • More research and consistent reporting are needed to define the role of AI in the diagnosis of eAMD. What is...

What are the benefits and risks of vitamin E for non-alcoholic fatty liver disease? Key messages It is unclear whether long-term treatment (18 months to 24 months) with vitamin E alone or in combination with vitamin C affects death due to any cause, serious unwanted effects, health-related quality of life, or non-serious unwanted effects when compared with placebo (dummy pill) or no treatment. Vitamin E alone probably reduces alanine transaminase and aspartate aminotransferase (liver enzyme) levels slightly. Further research is needed to increase our confidence in the evidence. What is...

Alpha 1 antitrypsin augmentation for alpha 1 antitrypsin deficiency associated lung disease This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of alpha 1 antitrypsin augmentation therapy on respiratory disease in people with alpha 1 antitrypsin deficiency. This is a protocol....

Do low blood pressure targets provide additional benefits for people with chronic kidney disease and high blood pressure compared to standard targets? Key messages • Lowering blood pressure in individuals with high blood pressure (hypertension) provides health benefits. But we do not know by how much blood pressure targets should be lowered for people with both hypertension and chronic kidney disease. • Compared to standard blood pressure targets, intensive (lower than standard) targets probably do not reduce deaths, serious unwanted and harmful events, or cardiovascular events (problems...

How accurate are alternative laboratory-based molecular tests (to RT-PCR with prior RNA extraction/purification) for identifying people infected by SARS-CoV-2? Key messages: * Transcription-mediated amplification (TMA) tests and commercially available reverse transcription polymerase chain reaction (RT-PCR) tests specifically designed to omit/adapt RNA extraction/purification appear accurate enough to replace the method of RT-PCR with prior RNA (a molecule essential for most biological functions) extraction/purification for identifying people infected by severe acute respiratory syndrome...

The experiences and perspectives of abortion seekers who travel for care: a qualitative evidence synthesis This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This QES aims to address the following question: What are the lived experiences and perceptions of abortion seekers (i.e. pregnant women, transgender men, and non-binary people of any gender) traveling to obtain care? The review objectives are to: synthesize the qualitative evidence to address the review question; identify factors that influence abortion travel experiences and perspectives, which may...

What are the benefits and harms of patient navigation for children and adolescents with chronic diseases? Key messages – We are very uncertain about the effects of patient navigator programmes compared with usual care on the quality of life of children and adolescents; the quality of life of their families; how many times they are admitted to hospital or go to the emergency department; how many school, day care, or college days they miss; and how much this costs. – There is currently a lack of evidence to determine the effects of patient navigator programmes on children and adolescents with...

What interventions help to prevent or treat BK virus infection in kidney transplant recipients? Key messages • People who have received a transplanted kidney because of kidney failure (a condition where the kidneys no longer function well enough to keep a person alive) are at risk of infection. This is because they have to take strong medications to dampen down the body's immune system (immunosuppressants) to prevent their body from fighting (rejecting) this new kidney. This puts them at risk of developing infection, which may affect the way the new kidney functions. A virus (BK virus) with...

Are interventions aimed at people with schizophrenia and their families more effective than standard care? Key messages • Family interventions may reduce relapse in individuals with schizophrenia. • Family interventions probably reduce caregiver burden and may improve expressed emotion (i.e. adverse family environment including family relationships and interaction patterns) in families of individuals with schizophrenia. • Additional studies are needed to allow any strong conclusions about family interventions for people with schizophrenia and their families. What is schizophrenia and how...

Can psychological or educational interventions (or combinations of both) reduce falls in older adults who live at home? Key messages – A psychological intervention (involving motivational interviewing (a method that aims to change behaviours by addressing uncertainties and encouraging personal commitment) and coaching) combined with tailored education (for example, advice on exercise or medication) makes little to no difference in the number of people who fall (fallers), but likely reduces the number of times people fall (though it is unclear by how much). - There was not enough good-quality...

What are the benefits and risks of vitamin D supplementation for adults with obesity undergoing weight-loss surgery? Key messages – There is limited evidence on the benefits of vitamin D supplements for adults with obesity after weight-loss surgery. We are not confident that taking high or moderate doses of vitamin D after weight-loss surgery improves vitamin D levels or reduces the diseases of the parathyroid glands (four pea-sized glands in the neck that manage calcium levels in the body). – There are no data on the risk of bone fractures, and little information on changes in bone strength...