What are the risks of therapies for treating multiple sclerosis? Key messages - Immunotherapies used to treat multiple sclerosis appear not to increase serious health events, compared to sham drugs (placebo). - Many of these drugs have unwanted effects and, for some of them, more people included in studies dropped out because of side effects compared to sham drugs. - These results are only partly, or are not, reliable since serious health events are relatively rare in people with multiple sclerosis, meaning that the issue is difficult to study, and serious health events were also not well...

Physician use of red flags to screen for fractured vertebrae for patients with new back pain This review describes the understanding of a common practice for checking for spinal injuries when patients come to a family practice doctor, back pain clinic or emergency room with new back pain. Doctors usually ask a few questions and examine the back to check for the possibility of a spinal fracture. The reason for this check for fractures is that the treatment is different for common back pain and fractures. Fractures are usually diagnosed with an x-ray, then treated with rest, a back brace and...

What are the benefits of training peer reviewers? Key messages • Training peer reviewers may have little or no effect on the quality of peer review. • Larger, well-designed studies are needed to give better estimates of the effect. What is a peer reviewer? A peer reviewer is a person who evaluates the research work done by another person. The peer reviewer is usually a researcher with skills similar to those needed to conduct the research they evaluate. What is peer review used for? Both funders and publishers of research can be uncertain if a research project or report is of good quality....

Pharmacological treatments in panic disorder in adults: a network meta-analysis Why is this review important? People with panic disorder are profoundly impacted by this condition, often experiencing challenges with work, education and social or family life. We wanted to evaluate which medications, if any, are the most effective and safe. In particular, we aimed to assess whether the network meta-analysis findings were valid enough to identify the best medications, in order to improve care. These analyses have also generated suggestions for future research to reduce key uncertainties in the...

Decongestants and antihistamines for acute otitis media in children This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of decongestants and antihistamines in the treatment of AOM in children. Specifically, we want to assess the impact of decongestants and antihistamines on the presence of otalgia, the persistence of AOM, the need for or change in antibiotic therapy, severe complications and adverse events. We also want to assess whether there are different effects depending on the method of AOM diagnosis, the age of the...

Perceptions and experiences of the prevention, detection and management of postpartum haemorrhage: a qualitative evidence synthesis What is the aim of this synthesis? Postpartum haemorrhage (PPH) is when women experience excessive blood loss after birth. PPH is the leading cause of maternal death. The aim of this Cochrane synthesis of qualitative evidence was to explore factors that influence PPH prevention, detection (identifying women with excessive blood loss), and management (treating women with PPH). To answer this question, we searched for and analysed qualitative studies that explored...

Mesh or no mesh: what works best for groin hernias (swelling or lump in the groin area) requiring emergency surgery? Key messages • Overall, we are uncertain about the effect of placing a mesh during emergency surgery in people with groin hernias. • The poor quality of the studies and the low number of people involved does not allow us to draw any firm conclusions. What are emergency groin hernias? A groin hernia is a bulge that protrudes through a weakness in the abdominal wall in the groin region. It is a common surgical condition in both men and women, but is notably more widespread among...

Human papillomavirus (HPV) self-sampling to encourage the uptake of cervical screening This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effect of inviting women to take a self-sampling test compared to the effect of inviting or reminding women to undergo conventional cervical screening. This is a protocol....

Stem cell-based therapies for stroke in newborns Review question Can stem cell-based therapies save the lives or improve the long-term development of newborns who have a stroke? Background Newborns sometimes develop stroke, which occurs when blood supply to part of the brain is blocked or when a blood vessel in the brain bursts. Babies with less severe stroke may make a full recovery or may have only mild intellectual problems. If the stroke is very big it can lead to death or to severe neurodevelopmental problems later in life. Some of these babies develop intellectual disabilities,...

How accurate is the CAM-ICU tool for the diagnosis of delirium in adult patients admitted to critical care units? Key messages Our review suggests that the CAM-ICU is a reasonable test to look for delirium in critical care settings. The test may be especially good for ruling out delirium. If the CAM-ICU suggests no delirium, it is unlikely the person has delirium. What was the aim of the review? To evaluate the accuracy of the CAM-ICU tool for detecting delirium in patients in critical care units. Why is recognizing delirium important? When people are unwell, they can experience changes in...

Interventions for preventing urinary tract infections in kidney transplant recipients This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This review aims to evaluate the safety, efficacy and patient-reported tolerability of interventions used to prevent UTIs in kidney transplant recipients. This is a protocol....

Infliximab for the treatment of active Crohn's disease Key messages – Infliximab used with purine analogues (azathioprine or 6-mercaptopurine) is probably more effective than purine analogues alone at getting Crohn's into remission. It may also be better at improving symptoms. The two treatments may be similar in terms of safety. – Infliximab alone may be more effective than purine analogues alone for getting Crohn's into remission and improving symptoms. The two treatments may be similar in terms of safety. – Infliximab may be as effective as the biosimilar at getting Crohn's into...

Is early or late tracheostomy more effective in critically ill COVID-19 patients who are expected to require long-term artificial ventilation? Key messages • For adults hospitalized with COVID-19 on mechanical ventilators, performing an early tracheostomy (where doctors cut through the skin into the trachea (windpipe) to insert a breathing tube) before 10 days after starting ventilation, may have little or no effect on deaths and the time patients spend on a ventilator compared with late tracheostomy, performed 10 days or more after starting ventilation. • We are uncertain whether early...

How accurate is artificial intelligence for diagnosing keratoconus? Key messages • The included studies suggest that artificial intelligence (AI) can identify keratoconus. This may lead to early detection and prevention of vision loss. • Estimates were similar for different types of AI algorithms. • We have little confidence in the evidence; there is a need for more research on this topic. What is keratoconus and why is (early) diagnosis so important? Keratoconus is a disease of the cornea (the clear window at the front of the eye) that affects people between the ages of 10 and 40 years. In...

Cognitive behavioural interventions for reducing fear of falling in older people living in the community Key messages – Cognitive behavioural therapy (CBT) with and without exercise probably reduces fear of falling in older people living in the community, when measured once treatment has ended. Improvements may be sustained during the first six months after treatment finished, and probably last beyond six months. – As a consequence of these interventions, people may be less likely to avoid activities after treatment and their level of depression may be reduced. – It is unclear if the...

Ventilation tubes (grommets) for otitis media with effusion (OME or 'glue ear') in children Key messages - From the studies included in this review, we are uncertain to what extent ventilation tubes improve hearing. Glue ear is a fluctuating condition, with high rates of spontaneous resolution and recurrence, which makes it difficult to study in a clinical trial. - Ventilation tubes may slightly reduce the number of children who have glue ear after three to six months of follow-up. It is not clear whether they also have an effect over longer periods of time. - Insertion of...

Interventions to prevent or cease electronic cigarette use in children and adolescents Key messages There are currently no published randomised controlled trials assessing the impact of interventions to prevent or stop e-cigarette use amongst children and adolescents. We did, however, find 22 of these types of studies underway that appear to be eligible for future updates to this review, which may provide more answers. What did we want to find out? We wanted to find out how effective interventions were in either preventing or ceasing (i.e. stopping) child and/or adolescent e-cigarette use....

Pulmonary rehabilitation using minimal equipment for people with chronic obstructive pulmonary disease This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of pulmonary rehabilitation with minimal equipment on key clinical outcomes in people with chronic obstructive pulmonary disease, compared to usual care, no training, or equipment-based training. This is a protocol....

Factors for predicting treatment success and severe adverse events of chimeric antigen receptor (CAR) T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: To identify and meta-analyse prognostic factors for efficacy and safety of CAR T-cell therapy for treating aggressive large B-cell lymphomas before therapy has started. Population Adult patients with a confirmed diagnosis of a relapsed or refractory aggressive large B-cell lymphoma (DLBCL, PMBCL, FL grade 3b, HGBCL) who received CAR...

What are the benefits and risks of health literacy interventions for migrants? Health literacy (HL) means the knowledge, motivation and competencies (e.g. reading and writing abilities) that people need to find, understand, evaluate and use health information. Migrants are at risk for difficulties in HL (e.g. when they don't know the country's health system well). 'Generic' HL means that people can find, understand and use general health information to make health decisions. 'Disease-specific' HL means that people can find, understand and use information about a certain disease or that they...