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...

Linked color imaging versus conventional white light colonoscopy for the detection of colorectal polyps This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and safety of LCI compared to WLI colonoscopy in detecting colorectal polyps in people requiring colonoscopy for screening, symptoms, or surveillance. This is a protocol....

Different types of percutaneous endovascular treatments for acute ischemic stroke Question Which type of endovascular treatment is best in terms of safety and effectiveness for people with acute ischemic stroke (AIS)? Background Stroke is one of the most common causes of death and disability today. Different endovascular (inside the blood vessel) treatments (also called thrombectomy) aim to remove the blood clot causing AIS to restore blood flow and reverse the stroke symptoms. Thrombo-aspiration involves sucking the clot away using a fine catheter tube. Stent-retriever thrombectomy grabs...

What are the benefits and risks of giving lactoferrin to full-term babies who had digestive tract surgery? Key message We found no medical studies that investigated the effects of giving lactoferrin (a protein found in milk) to babies born at full-term (at or after 37 weeks of pregnancy) who had surgery of their digestive tract. What is lactoferrin? Lactoferrin is a protein found in milk that can protect against infection. Lactoferrin supplements are available and have been researched in premature babies. There is some evidence that lactoferrin can prevent infection in premature babies. What...

Lubricating drops for contact lens discomfort in adults This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the efficacy and safety of lubricating drops for ocular discomfort associated with contact lens wear in adults. This is a protocol....

Case management programmes for older people living with frailty in the community Key messages • Case management programmes for older people living with frailty in the community may make little or no difference to patient and service outcomes and care-related costs. • There is insufficient evidence to warrant any current change in practice. • Futures trials are needed to determine which elements of these programmes benefit different people. Why is this review important? The number of people living with frailty aged 65 years and older is increasing around the world. There is no standard...

Exercise interventions for adults after liver transplantation Background Levels of physical activity tend to decrease in people who receive a liver transplant. The benefits and harms of exercise interventions to protect against the development of heart and lung diseases, hypertension, type II diabetes, dementia, non-alcoholic fatty liver disease (conditions caused by a build-up of fat in the liver), cancer, or other life-threatening diseases which may develop rapidly have not yet been well studied. What did we want to find out? We wanted to determine the benefits and harms of exercise in...

Balanced crystalloid solutions versus 0.9% saline for severely dehydrated children with acute diarrhoea What is dehydration and how it is treated? Children with acute diarrhoea or gastroenteritis who get severely dehydrated require intravenous (into a vein) rehydration with fluids (called intravenous correction). The most common intravenous solutions used for this purpose are the so-called crystalloids, which are solutions of mineral salts (e.g. electrolytes such as sodium, potassium, or chloride). The most commonly used crystalloid for rehydrating children is 0.9% saline solution. It is...

Safety and efficacy of proton pump inhibitors in preterm infants with gastroesophageal reflux disease This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the safety and efficacy of proton pump inhibitors (PPIs) for the treatment of preterm infants with diagnosed or suspected gastroesophageal reflux disease (GERD). This is a protocol....

Vaccines for the prevention of infections in adults with solid tumors This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of vaccines for the prevention of infections in adults with solid tumors. This is a protocol....

How effective are antidepressants used to treat chronic pain and do they cause unwanted effects? Key messages • We are only confident in the effectiveness of one antidepressant: duloxetine. We found that a standard dose (60 mg) was effective, and that there is no benefit to using a higher dose. • We are uncertain about unwanted effects for any antidepressant as the data for this were very poor. Future research should address this. • In clinical practice for chronic pain, a standard dose of duloxetine may be considered before trying other antidepressants. • Adopting a person-centred approach...

Interventions to reduce harmful alcohol use in low- and middle-income countries Why is this review important? Harmful alcohol use is one of the main contributors to the global burden of disease. In low- and middle-income countries, harmful alcohol use is increasing. However, services to prevent and treat harmful alcohol use are limited. One contributor to the lack of available services is the limited information about which intervention approaches are effective in reducing harmful alcohol use and whether these approaches are feasible and acceptable in low-resource settings. In order to...

Closure of mesenteric defects for prevention of internal hernia after Roux-en-Y gastric bypass in bariatric surgery This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and safety of defect closure for prevention of internal hernia after Roux-en Y gastric bypass (RYGB) in bariatric surgery. This is a protocol....

Family presence during resuscitation Why is this question important? Patients and their relatives increasingly expect to be actively involved in the decisions of treatment. However, there are concerns that family presence during resuscitation (FPDR) can lead to post-traumatic stress disorder (PTSD)-related symptoms in relatives, or have a negative impact on the performance of healthcare professionals, thereby hampering the quality of critical care. There are also concerns that patient confidentiality can be violated, as the patient's thoughts and preferences in the situation are unspoken....

Is measuring bilirubin levels through the skin a reliable alternative to measuring bilirubin levels in the blood of newborns? Key messages The studies included in this review suggest that measuring bilirubin levels through the skin without a needle can identify high bilirubin levels in newborns. Why is it important to diagnose high bilirubin levels in newborns? Bilirubin is a substance produced through the breakdown of red blood cells. Jaundice is a very common problem in the newborn period and results from high levels of bilirubin in the blood (hyperbilirubinaemia). It is important to...

Hepatitis B immunisation for adults with end-stage kidney disease This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objectives We aim to evaluate the beneficial and harmful effects of: hepatitis B immunisation in people with end-stage kidney disease. Secondary objectives We aim to evaluate the beneficial and harmful effects of: reinforced vaccination series (three doses plus one additional booster) versus traditional triple inoculations; and intradermal versus intramuscular hepatitis B vaccination, in people with end-stage kidney disease. This is...

Chlorhexidine or other antiseptic solutions: which works better to prevent infection in newborns with central lines? Key messages: • Due to a lack of robust evidence, the benefits and risks of chlorhexidine in alcohol compared to povidone-iodine (PI) as antiseptic solution for central line insertion in newborns are unclear. • The use of povidone in premature infants may reduce the level of thyroid hormone, which is an essential hormone for growth and development. • The limited number of studies and the lack of studies from low- and middle-income countries reduce our confidence in the...

Initial treatment for adults with advanced kidney cancer (renal cell carcinoma) Abbreviations • renal cell carcinoma (RCC) • avelumab (AVE) • axitinib (AXI) • cabozantinib (CAB) • ipilimumab (IPI) • lenvatinib (LEN)) • nivolumab (NIV) • pazopanib (PAZ) • pembrolizumab (PEM) • sunitinib (SUN) Key messages • When making treatment decisions, it is important to think about whether drugs lengthen life, and whether they decrease or increase harmful side effects. • The findings in this review apply mostly to advanced renal cell carcinoma (RCC) with a clear cell component. What is advanced RCC, and...