Retrograde distal vascular access versus femoral artery access for below the knee arterial angioplasty Key messages – The choice of vascular access can influence the outcome of below the knee angioplasty. – We identified no trials that compared retrograde distal access with femoral access for below the knee angioplasty for inclusion; there is a need for high-quality trials on this topic. What is peripheral artery disease? Peripheral artery disease is a stenosis (narrowing) or occlusion (blocking) of the limb arteries usually caused by the build-up of fatty deposits in the arteries (known as...

Vitamin B12 supplementation for women during pregnancy Key messages – Women who took vitamin B12 supplements during pregnancy may have improved vitamin B12 status during pregnancy or postpartum, including less vitamin B12 deficiency and higher vitamin B12 levels, compared to women who did not take vitamin B12 supplements, but the evidence is uncertain. – The effects of taking vitamin B12 supplements during pregnancy on other health outcomes in pregnant women or their children are not known. Public health implications Vitamin B12 is an important nutrient that helps keep your body's blood and...

Treatments to thin the blood during haemodialysis: which treatments reduce clotting problems without causing bleeding? What is the issue? When people have dialysis using a machine to clean their blood (called haemodialysis (HD)), blood-thinning treatment helps prevent blood clots in the dialysis tubing. However, thinning the blood too much with treatment can lead to bleeding problems. There are several different medications to thin the blood, but it is not clear which is the best or the safest choice. What did we do? We searched for all the research trials that assessed the blood thinning...

Pressure garments for preventing hypertrophic scarring after burn injury Key messages – We do not know if pressure garment therapy is more effective than other scar treatment options (e.g. silicone gel/sheets, massage with lanolin) for preventing an abnormally thick and raised scar (hypertrophic scarring). – Future studies should include more participants who are monitored for longer; should clearly report on any other treatments that are offered alongside or as an alternative to pressure garment therapy; and measure outcomes that are most important to people with burn injuries. What are...

Are population-based interventions (those aimed at entire communities rather than individuals) helpful in preventing falls and fall-related injuries in older people? Key messages: • We are unsure whether approaches to falls prevention that target the whole community reduce falls and fall-related injuries. • Future studies should be well-designed and use up-to-date descriptions of their interventions. Ideally, studies should be carried out in several communities (rather than just two study communities), each with large populations, and types of older people living in the study communities...

What are the benefits and harms of ibuprofen for managing pain after an operation in children? Key messages • Ibuprofen probably reduces pain intensity just after an operation up to two hours compared to a placebo (dummy) and compared to paracetamol. The evidence compared to other medicines and in the longer term is unclear or lacking. • Overall, we are uncertain about unwanted effects of ibuprofen, especially serious unwanted effects, since the studies in the review rarely measured them. • Future studies should examine ibuprofen compared to commonly used medications and measure benefits and...

Community views on mass drug administration for soil-transmitted helminths: a qualitative evidence synthesis This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To synthesize qualitative research evidence about community experience with, and perception of, mass drug administration (MDA) programmes for soil-transmitted helminths (STHs). To assess how findings confirm, extend, enrich, or conflict with those previously identified for MDA programmes for lymphatic filariasis. This is a protocol....

Is maintenance therapy following previous treatment better than observation or placebo for treating chronic lymphocytic leukaemia in adults? What is the aim of this review? We aimed to determine whether the currently available maintenance treatments for disease control in adults with chronic lymphocytic leukaemia (CLL) have an acceptable balance between benefits and harms following previous treatment. Key messages We found that maintenance therapy in adults with CLL after previous therapy probably has little to no effect on long-term survival. We also found that maintenance therapy probably...

Methylxanthine for preventing morbidity and mortality in preterm infants: a network meta-analysis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of methylxanthines (caffeine; theophylline or aminophylline) and 'no methylxanthine administration' on morbidity and mortality in preterm infants, using network meta-analysis. This is a protocol....

Oral or nasal steroids for otitis media with effusion (OME or 'glue ear') in children Key messages Taking steroids in tablet or syrup form (by mouth) may have little or no impact on hearing and quality of life for children with glue ear. Steroids may reduce the number of children who have glue ear after 6 to 12 months, but we are uncertain how large this reduction might be. Using a steroid nasal spray may also make little or no difference to hearing or quality of life, although the evidence is not as robust. It is also unclear whether nasal steroids affect the number of children...

Riboflavin supplements for blood pressure lowering in adults This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and safety of riboflavin supplements compared to placebo or no additional treatment for lowering systolic and diastolic blood pressure. This is a protocol....

Non-surgical treatment for lower limb apophyseal injuries This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of non-surgical treatment versus placebo or no treatment for lower limb apophyseal injuries in children and adolescents on pain, function, participation in physical activity, and participant-reported treatment success. This is a protocol....

What effects does enzyme replacement therapy (ERT) have on people with late-onset Pompe disease (LOPD)? Key messages • Late-onset Pompe disease (LOPD) is a rare condition that causes people to become more unwell over time. Enzyme replacement therapy (ERT) can help to slow disease progression. • Alglucosidase alfa (a type of ERT) probably improves some aspects of disease progression in people with late-onset Pompe disease (LOPD) compared to placebo (an inactive or 'dummy' medicine). • Future studies should monitor participants for as many years as possible to better understand the long-term...

Exercise for multidirectional instability of the shoulder This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of exercise therapy for multidirectional instability of the shoulder. This is a protocol....

Can endoscopic sinus surgery (i.e. surgery using a long thin tube inserted into the sinuses) help to treat nasal polyposis (soft growths in the nasal passages called polyps) in people with cystic fibrosis (CF)? Key messages We are uncertain whether nasal irrigation together with an endoscopic sinus surgery intervention improves symptoms and lung function or reduces the need for antibiotics compared to nasal irrigation alone. There was one episode of bleeding during surgery that was corrected during the procedure with no further consequences. What is CF? CF is a genetic condition that affects...

Can reducing prescriptions of anticholinergic medicines improve cognitive outcomes in older adults? Key messages • It is known that older people who take more medicines with an anticholinergic effect may be at greater risk of cognitive decline. • There is a lack of high-quality evidence to show whether reducing prescriptions of anticholinergic medicines can preserve or improve cognition. Current evidence is very uncertain and very short-term. • There is a need for large trials to investigate long-term effects of reducing anticholinergic burden. What are anticholinergic medicines? Medicines...

Transanal tube for the prevention of anastomotic leakage in rectal cancer surgery This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of a transanal tube for the prevention of anastomotic leakage in people undergoing rectal cancer surgery. This is a protocol....

5-alpha-reductase inhibitors for difficulties in urination related to prostatic enlargement Review question What are the effects of medications, so-called 5-alpha reductase inhibitors (5ARI), work in men with bothersome urinary symptoms. Background An enlarged prostate can cause bothersome urinary symptoms like having to go often, having a weak unary stream or having the feeling of not emptying the bladder completely, especially in older men. 5ARIs are medications that shrink the prostate in size and may help improve men's symptoms. Study characteristics We found 27 studies that compared...

Automated oxygen delivery for preterm infants with breathing difficulties who need breathing support Key messages 1. Preterm infants who receive automated oxygen delivery probably spend more time in the desired oxygen saturation range compared to those who receive routine manual oxygen delivery. However, it is unclear whether this effect reduces their risk of death, severe eye disease, or brain development problems. 2. We were unable to draw firm conclusions on the effectiveness of automated oxygen delivery compared with enhanced manual oxygen delivery, or of one automated delivery system...

Progestogens versus gonadotrophin-releasing hormone (GnRH) agonists, GnRH antagonists and other progestogens for women undergoing assisted reproductive technology (ART) Review question Cochrane authors reviewed the evidence about the effect of progestogens versus gonadotrophin-releasing (GnRH) agonists, GnRH antagonists and other progestogens in women undergoing assisted reproductive technology. Background GnRH agonists and antagonists are medications that affect hormones related to fertility. They are commonly used to prevent a hormone called luteinising hormone from causing a premature...