What are the benefits and risks of ocrelizumab for multiple sclerosis? Key messages – Ocrelizumab is a recently approved medicine to treat people with multiple sclerosis (MS). In relapsing-remitting MS (where people experience flare-ups of symptoms), ocrelizumab probably substantially reduces flare-ups, may substantially reduce worsening of symptoms, and probably makes little or no difference to unwanted effects compared with interferon beta-1a (a standard treatment for MS), 96 weeks after treatment starts. – Compared to placebo (a dummy medicine) after 120 weeks of treatment for primary...

Tourniquet use for people with peripheral arterial disease undergoing major lower limb amputations This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the safety and effectiveness of tourniquet use in people undergoing major lower limb amputation for complications of peripheral arterial disease, specifically with regard to intraoperative blood loss, change in haemoglobin levels, transfusion rates, wound healing, and need for additional surgery. This is a protocol....

The use of antibiotics in the treatment of ulcerative colitis What was the aim of this review? This Cochrane Review aimed to determine whether antibiotics are useful and safe for people with ulcerative colitis (UC) in achieving or maintaining remission. Key messages We found that antibiotics, when added to standard therapies, are similar to placebo in how often they fail to achieve remission or disease improvement for people with UC, measured up to three months from taking them. We found that antibiotics when compared to placebo may be useful in achieving remission or some improvement of UC...

Inserting a contraceptive implant at the same visit as an abortion or at a follow-up visit Review question We compared the initiation rate, effectiveness, and side effects of insertion of a contraceptive implant (implant for birth control) at the same visit as an abortion versus delayed insertion at a follow-up visit. Background The contraceptive implant is a highly effective method of birth control that is reversible and provides long duration of pregnancy protection. This method is suitable for almost all women, including women who have a pregnancy ended by removal or expulsion. Because...

Regional analgesia with or without general anaesthesia for breast cancer surgery: a network meta-analysis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess whether the analgesic efficacy and safety differ according to the regional analgesia technique used in women undergoing breast cancer surgery. This is a protocol....

Endovascular treatment for vertebral artery stenosis Question Is endovascular treatment plus medical treatment beneficial for people with symptomatic vertebral artery stenosis compared to medical treatment alone? Background The vertebral artery is the blood vessel that supplies the back of the brain. Narrowing of this vessel (vertebral artery stenosis) is an important cause of stroke, but not everyone who has vertebral artery stenosis will have symptoms. Medical treatment (mainly including controlling risk-factors and drug treatment), surgery, and endovascular treatment (dilation of the...

Drugs given to pregnant women and their babies to keep them still during fetal surgery and other invasive procedures on the baby We looked for evidence from randomised controlled trials on the effectiveness of anaesthetic and pain relief medication for preventing fetal movements (fetal immobilisation) to allow surgical and other invasive procedures to be performed safely on the unborn fetus whilst still in the mother's uterus. What is the issue? Use of ultrasound during pregnancy has made great advances resulting in increased diagnosis of problems with the development of unborn babies. Many...

Anaesthesia and analgesia in the emergency care setting for treating distal radius fractures in adults This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The primary aim of this review is to assess the benefits and harms of different methods of anaesthesia and analgesia for the initial treatment of DRF in adults in the emergency care setting. The secondary aim of this review is to assess these outcomes in different age groups, fracture types, physicians performing the procedure, populations based on different geographical regions, and in closed reduction...

Pain management for medical abortion before 14 weeks' gestation Key Messages • Ibuprofen has the best evidence for managing pain during medical abortion in the first 14 weeks of pregnancy, but the best dose is unclear. • Further studies are needed along with a robust, consistent way of recording pain. What is medical abortion? There are two main types of abortion - surgical or medical. Surgical abortion is carried out by specialist doctors in a clinic. In medical abortion, women take medicine ('abortion pills' consisting of mifepristone and misoprostol) to end their pregnancy. Medical...

Stem cells for treating patients not responding to Crohn's disease treatment Question Are stem cells (SCs) an effective and safe option in patients with Crohn's disease (CD) when they do not respond to their standard medical treatment? Key messages Stem cells when combined with standard medical treatment could be better than the medical treatment alone or with a placebo (a dummy treatment) in the healing of the opening in the perianal region connected to the bowels caused by CD (perianal fistula). Stem cells when combined with standard medical treatment could be safe when compared to...

Doppler trans-thoracic echocardiography for detection of pulmonary hypertension in adults What was studied in this review? Pulmonary hypertension is high blood pressure in the blood vessels that supply blood from the right half of the heart to the lungs. It is a serious condition that can damage the right side of the heart. The walls in the blood vessels become thick and stiff which makes it harder for the blood to flow. This can lead to heart failure. Symptoms can include shortness of breath, tiredness, chest pain, a racing heartbeat or swelling in the lower limbs and abdomen. The symptoms...

Perioperative use of disease modifying anti-rheumatic drugs (DMARDs) in people with inflammatory arthritis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of perioperative interruption versus continuation of biologic, conventional synthetic, and targeted synthetic disease modifying anti-rheumatic drugs in people with inflammatory arthritis, in terms of worsening of underlying inflammatory disease and postoperative complications, such as infection and altered wound healing. This is a protocol....

Proton pump inhibitors for the prevention of non-steroidal anti-inflammatory drug-induced ulcers and dyspepsia This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of proton pump inhibitors on the prevention of dyspepsia and ulcers in individuals with chronic consumption of non-steroidal anti-inflammatory drugs. This is a protocol....

Mental health support in the community for refugee children and adolescents in high-income countries Refugee children and adolescents who have settled in high-income countries are at risk of mental health problems due to the many challenges they face before, during, and after migration. Key message The evidence to date is not of sufficient quantity or quality to recommend what interventions should be implemented in practice. It is necessary for existing mental health support programmes and interventions for child refugees and asylum seekers to be evaluated so that they can add to the...

Music therapy for people with substance use disorder What was the aim of this review? We aimed to assess if music therapy given in addition to standard care was effective for people with substance use disorders, in terms of impacting substance craving, motivation for treatment, and motivation for staying sober/clean. We were also interested in evidence about effects on depression and anxiety, as these are risk factors for relapse. Key messages Music therapy as 'add on' treatment to standard care likely reduces substance craving and increases motivation for treatment for adults in...

What are the benefits and risks of negative pressure wound therapy for managing the open abdomen in people who are not trauma patients? Key messages - We do not know if negative pressure wound therapy (NPWT, defined as pressure lower than a given reference pressure, generally causing suction) helps abdominal wounds to heal quicker or reduces potential harmful effects compared with using a Bogota bag (a sterilised fluid bag used for closing abdominal wounds). - We do not know if a Suprasorb CNP system (a type of NPWT) helps abdominal wounds to heal quicker or reduces potential harmful effects...

Interventions to reduce the risk of coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection among workers outside healthcare settings What is the aim of this review? Coronavirus (COVID‐19) is a respiratory infectious disease that has spread globally. People infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) can develop critical illnesses and may die, particularly older people, and those with underlying medical problems. Different interventions that attempt to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace have been...

Educational interventions for health professionals managing people with COPD in primary care Background: Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable lung disease. COPD makes it harder for a person to get air in and out of the lungs. Symptoms include shortness of breath, cough, excess phlegm and wheezing. COPD can cause a huge impact on a person's life and lead to poor health. Question: What evidence exists for educational interventions delivered to health professionals managing COPD in primary care? Search strategy: To find relevant studies, we...

How accurate are magnetic resonance imaging (MRI) scans for detecting liver cancer? Key messages In people with chronic liver disease, magnetic resonance imaging (MRI: cross-sectional scans inside the body) probably misses liver cancer in 16% of people, who would not receive timely or appropriate treatment, and incorrectly finds liver cancer in 6% of people, who would receive unnecessary treatment. MRI probably misses liver cancer in 16% of people with liver cancer who could have surgery to remove part of their liver, and incorrectly finds liver cancer in 7% of people who undergo...

Comprehensive Geriatric Assessment for older people in the community at risk of poor health outcomes With increased life expectancy worldwide, there is an urgent need to explore different ways to deliver appropriate healthcare to older people who require it in the most appropriate setting. More older people are now living with frailty, a clinical syndrome characterised by vulnerability to adverse health outcomes including early death, nursing home admission or loss of independence. We wanted to find out if organised and co-ordinated care delivered by healthcare professionals such as doctors,...