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...

Electronic symptom monitoring for patients with advanced cancer This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of electronic symptom monitoring (ESM) on patient survival, hospital admission, emergency visit, changes in treatment protocol, adverse events, patient-reported outcomes (PROs), and cost-effectiveness for patients with advanced cancer. This is a protocol....

Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence What is primary healthcare integration? Primary healthcare integration is a way of combining different primary healthcare services that have previously been delivered separately. The aim of this integration is usually to give people better access to healthcare and to make more efficient use of limited health resources. Why is it important to know about healthcare workers' views and experiences? Primary healthcare integration has been implemented in many different...

Extensive intraoperative peritoneal lavage for resectable advanced gastric cancer This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and safety of extensive intraoperative peritoneal lavage for resectable advanced gastric cancer. This is a protocol....

Drugs to improve placental function in pregnant women carrying babies with poor growth What is the issue? In approximately 0.4% of pregnancies, the unborn baby suffers from poor growth because the placenta is unable to provide adequate nutrition. These babies are at high risk of dying in the womb due to the poor supply of nutrition and oxygen. Because of this, doctors often deliver these babies before full term, in order to feed them outside the womb. But such early births mean the babies are premature and of very low birthweight. Because of this, these babies are at risk of severe health...

Best therapy for people with advanced non-small cell lung cancer who have not been treated without a targetable mutation and moderately impaired performance status Key messages – The preferred chemotherapy for people with moderately impaired performance status (PS) with advanced non-small cell lung cancer (NSCLC) and that have never received any treatment before should contain two medicines, one of which is a platinum-based medicine. – Although the risk for bone marrow damage is higher with a platinum-based medicine, these events are often relatively mild and easy to treat. – We were unable...

Omega-3 fatty acid supplementation for distal symmetrical peripheral neuropathy in adults with diabetes mellitus This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of omega-3 polyunsaturated fatty acid (PUFA) supplements as a treatment for DSPN in people with diabetes mellitus compared to placebo or no treatment. This is a protocol....

Fenestrated endovascular repair for abdominal aortic aneurysms This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of complex stent-graft fenestrated endovascular aneurysm repair (FEVAR) versus open surgical repair or conservative (non-operative) management for people with complex abdominal aortic aneurysms. This is a protocol....