Procalcitonin for the diagnosis of sepsis in neonates: a diagnostic test accuracy review This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To evaluate the diagnostic accuracy of procalcitonin in culture proven early- or late-onset neonatal sepsis. Secondary objectives To evaluate the diagnostic accuracy of procalcitonin in all sepsis (including both culture-proven and culture-negative early- or late-onset neonatal sepsis). To evaluate the diagnostic accuracy of procalcitonin in all sepsis at the most common threshold ranges used (0.5 to 1 ng/mL and ≥ 2...

Training health workers in breast examination for early detection of breast cancer in low- and middle-income countries What is the issue? Limited screening services and inadequate health systems in low- and middle-income countries (LMICs) leads to late diagnosis of breast cancer among women living in LMICs. Advanced screening for breast cancer (using mammography) is mostly unavailable in many health facilities and, if available, is too expensive for most women. This Cochrane Review examines whether training health workers based in LMICs in clinical breast examination (CBE) would have any...

Conservative interventions for managing urinary incontinence after prostate surgery Key messages - In men who have urinary incontinence following prostate surgery, combined non-pharmacological and non-surgical treatments may make little difference to continence, quality of life or the number of men experiencing adverse events as a result of the interventions. - The evidence is uncertain as to whether pelvic floor muscle training combined with biofeedback has any effect on incontinence or quality of life, while no evidence was identified assessing electrical stimulation for our key outcomes...

Glucagon-like peptide 1 (GLP-1) receptor agonists for people with chronic kidney disease and diabetes This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This review aims to assess the benefits and harms of GLP-1 receptor agonists to treat diabetes in people with CKD. This is a protocol....

Perampanel add-on for drug-resistant focal epilepsy Key messages Add-on perampanel is effective at reducing seizure frequency and may maintain seizure freedom for people with drug-resistant focal epilepsy. Perampanel is well-tolerated at doses of 8 mg/day or less. What is epilepsy? Epilepsy is one of the most common brain disorders. Approximately 30% of people with epilepsy continue to have seizures (sudden bursts of electrical activity in the brain that change how it works for a short time) despite adequate therapy with antiepileptic medicines. These people are regarded as having...

Post-incident debriefing for people with schizophrenia after coercive measures This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate the effects of post-incident debriefing after coercive measures for people with schizophrenia or schizophrenia-type psychosis. This is a protocol....

Digital technology for early identification of chest infections in people with cystic fibrosis Review question Can digital technology identify chest infections in people with cystic fibrosis (CF) earlier than with standard care and how does this affect clinical outcomes? What is cystic fibrosis? CF is a life-limiting condition affecting several body organs, especially the lungs. Chest infections can worsen the damage in the lungs of people with CF. Identifying chest infections early and treating them quickly is very important. Digital technology, such as smartphone applications (apps) and...

Is general anesthesia or loco-regional anesthesia better for people needing an endovascular repair of an aortic aneurysm? Key messages - we did not find any randomized controlled trials to help answer our question - there is a need for high-quality evidence to compare the benefits and harms of general anesthesia compared to loco-regional anesthesia in people undergoing endovascular repair of an aortic aneurysm What is an aortic aneurysm? When the diameter of arteries or veins grows beyond a certain size, they are known as aneurysms. Aneurysms that continue to grow beyond a certain size are...

How effective are non-drug treatments used to prevent attacks of vestibular migraine? Key messages It is not clear whether any of these treatments are effective at preventing attacks of vestibular migraine. Few studies have assessed the possible benefits and harms of using these treatments to prevent attacks. The studies found are small and the results are inconclusive. What is vestibular migraine? Migraine (sometimes known as 'headache migraine') is a common condition that causes recurrent headaches. Vestibular migraine is a related condition where the main symptoms are recurring episodes...

How effective are medicines used to prevent attacks of vestibular migraine Key messages It is not clear whether any medications are effective at preventing attacks of vestibular migraine. There are very few studies that have assessed the possible benefits and harms of taking medication to prevent attacks. The available studies are small and the results are inconclusive. Further work is needed in this area to help establish whether there are any treatments that may improve this condition. What is vestibular migraine? Migraine (sometimes known as 'headache migraine') is a common condition that...

How effective are medicines used to treat attacks of vestibular migraine? Key messages It is not clear whether any medications are effective at treating attacks of vestibular migraine. There are few studies that have assessed the possible benefits and harms of taking medication at the time of an attack. The available studies are small and the results are inconclusive. Further work is needed in this area to help establish whether there are any treatments that may be used to help relieve the symptoms of a vestibular migraine attack. What is vestibular migraine? Migraine (sometimes known as...

Treatments to manage patent ductus arteriosus in premature babies Review question What treatments are effective and safe in preventing or treating a common heart condition, called patent ductus arteriosus (PDA) in premature babies? Background PDA is a common complication among premature and low birthweight babies. PDA is an open blood vessel channel between the lungs and the heart, which usually closes shortly after birth. In premature and low birthweight babies, the PDA may remain open, and may contribute to life-threatening complications. We wanted to see what treatments can safely and...

High-dose caffeine compared to standard-dose caffeine in preterm newborns at risk of lung disease Key messages • Although caffeine is commonly given to babies born too early, its most effective dose is unclear. • Higher doses of caffeine might improve breathing and long-term development, but it potentially has unwanted effects. Why give caffeine to babies born too early? Newborns born too early (preterm), especially before 28 weeks of pregnancy, have a higher risk of death, lung disease, and brain impairment than those born at or near term. For instance, some of these babies develop...

Rituximab for myasthenia gravis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess: the safety and efficacy, as assessed by the effect on disease severity or functional ability and the burden of alternative treatment, of rituximab (including biosimilar variants) for the treatment of myasthenia gravis in adults; and outcomes and adverse effects between different patient subgroups, and treatment strategies, in order to aid treatment choice for individuals, and to inform policymakers about those most likely to benefit. This is a protocol....

Is the McKenzie method effective for the treatment of (sub)acute non-specific low back pain? Key messages The McKenzie method may result in little to no benefit in pain and disability in people with (sub)acute non-specific low back pain in the short term (closest to two weeks) and in the intermediate term (closest to three months). The McKenzie method is not an effective treatment for (sub)acute non-specific low back pain. We do not know whether the McKenzie method leads to any side effects as none of the trials included in this review measured any side effects. What is (sub)acute...

Silymarin for treatment of adults with nonalcoholic fatty liver disease This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of silymarin in adults with nonalcoholic fatty liver disease (NAFLD). This is a protocol....

Opioids for managing pain in babies exposed to painful procedures Key messages • Due to a lack of strong evidence, the benefits and risks of opioids for managing pain in babies exposed to painful procedures are unclear. • Compared to placebo (a 'dummy' treatment, or sham treatment, that does not contain any medicine but looks identical to the medicine being tested), opioids may reduce pain assessed with certain scales during the procedure, but may not make a difference with other scales one to two hours after the procedure. • The evidence is very uncertain about the effect of opioids on:...

Painkillers other than opioids to treat pain in babies undergoing painful procedures Key messages • We did not find enough evidence on painkillers that are not opioids to manage pain in babies undergoing painful procedures. We found only two small studies that compared a painkiller (ketamine) with either another painkiller (an opioid) or sweet solution to manage different procedures. • Larger studies on a variety of painkillers are needed to provide a better understanding of the benefits and harms of the different painkillers and the best way to give them. What did we want to find out?...

Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews Key messages For acute low back pain • NSAIDs and muscle relaxants may provide small benefits on pain, however muscle relaxants may be associated with unwanted effects. Paracetamol had no effect on pain or unwanted effects. For chronic low back pain • Opioids may reduce pain but may be associated with unwanted effects. NSAIDs may reduce pain without unwanted effects and antidepressants may make little or no difference on pain. • Physicians should discuss the possibility for a small effect on pain and...

Pressure sources for nasal continuous positive airway pressure (CPAP) in preterm infants Key messages Bubble continuous positive airway pressure (CPAP) may reduce the risk of CPAP treatment failure when compared with CPAP delivered by mechanical ventilators or Infant Flow Driver. Bubble CPAP probably has little or no impact on the risk of death or other complications associated with premature birth but likely increases the risk of moderate-severe nasal injury. What is CPAP? CPAP is a form of breathing support that can be used to support breathing in a preterm (premature) baby with lung...