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...

What are the risks of therapies for treating multiple sclerosis? Key messages - Immunotherapies used to treat multiple sclerosis appear not to increase serious health events, compared to sham drugs (placebo). - Many of these drugs have unwanted effects and, for some of them, more people included in studies dropped out because of side effects compared to sham drugs. - These results are only partly, or are not, reliable since serious health events are relatively rare in people with multiple sclerosis, meaning that the issue is difficult to study, and serious health events were also not well...

Physician use of red flags to screen for fractured vertebrae for patients with new back pain This review describes the understanding of a common practice for checking for spinal injuries when patients come to a family practice doctor, back pain clinic or emergency room with new back pain. Doctors usually ask a few questions and examine the back to check for the possibility of a spinal fracture. The reason for this check for fractures is that the treatment is different for common back pain and fractures. Fractures are usually diagnosed with an x-ray, then treated with rest, a back brace and...

What are the benefits of training peer reviewers? Key messages • Training peer reviewers may have little or no effect on the quality of peer review. • Larger, well-designed studies are needed to give better estimates of the effect. What is a peer reviewer? A peer reviewer is a person who evaluates the research work done by another person. The peer reviewer is usually a researcher with skills similar to those needed to conduct the research they evaluate. What is peer review used for? Both funders and publishers of research can be uncertain if a research project or report is of good quality....

Pharmacological treatments in panic disorder in adults: a network meta-analysis Why is this review important? People with panic disorder are profoundly impacted by this condition, often experiencing challenges with work, education and social or family life. We wanted to evaluate which medications, if any, are the most effective and safe. In particular, we aimed to assess whether the network meta-analysis findings were valid enough to identify the best medications, in order to improve care. These analyses have also generated suggestions for future research to reduce key uncertainties in the...

Decongestants and antihistamines for acute otitis media in children This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of decongestants and antihistamines in the treatment of AOM in children. Specifically, we want to assess the impact of decongestants and antihistamines on the presence of otalgia, the persistence of AOM, the need for or change in antibiotic therapy, severe complications and adverse events. We also want to assess whether there are different effects depending on the method of AOM diagnosis, the age of the...

Perceptions and experiences of the prevention, detection and management of postpartum haemorrhage: a qualitative evidence synthesis What is the aim of this synthesis? Postpartum haemorrhage (PPH) is when women experience excessive blood loss after birth. PPH is the leading cause of maternal death. The aim of this Cochrane synthesis of qualitative evidence was to explore factors that influence PPH prevention, detection (identifying women with excessive blood loss), and management (treating women with PPH). To answer this question, we searched for and analysed qualitative studies that explored...

Mesh or no mesh: what works best for groin hernias (swelling or lump in the groin area) requiring emergency surgery? Key messages • Overall, we are uncertain about the effect of placing a mesh during emergency surgery in people with groin hernias. • The poor quality of the studies and the low number of people involved does not allow us to draw any firm conclusions. What are emergency groin hernias? A groin hernia is a bulge that protrudes through a weakness in the abdominal wall in the groin region. It is a common surgical condition in both men and women, but is notably more widespread among...

Human papillomavirus (HPV) self-sampling to encourage the uptake of cervical screening This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effect of inviting women to take a self-sampling test compared to the effect of inviting or reminding women to undergo conventional cervical screening. This is a protocol....

Stem cell-based therapies for stroke in newborns Review question Can stem cell-based therapies save the lives or improve the long-term development of newborns who have a stroke? Background Newborns sometimes develop stroke, which occurs when blood supply to part of the brain is blocked or when a blood vessel in the brain bursts. Babies with less severe stroke may make a full recovery or may have only mild intellectual problems. If the stroke is very big it can lead to death or to severe neurodevelopmental problems later in life. Some of these babies develop intellectual disabilities,...

How accurate is the CAM-ICU tool for the diagnosis of delirium in adult patients admitted to critical care units? Key messages Our review suggests that the CAM-ICU is a reasonable test to look for delirium in critical care settings. The test may be especially good for ruling out delirium. If the CAM-ICU suggests no delirium, it is unlikely the person has delirium. What was the aim of the review? To evaluate the accuracy of the CAM-ICU tool for detecting delirium in patients in critical care units. Why is recognizing delirium important? When people are unwell, they can experience changes in...

Interventions for preventing urinary tract infections in kidney transplant recipients This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This review aims to evaluate the safety, efficacy and patient-reported tolerability of interventions used to prevent UTIs in kidney transplant recipients. This is a protocol....

Infliximab for the treatment of active Crohn's disease Key messages – Infliximab used with purine analogues (azathioprine or 6-mercaptopurine) is probably more effective than purine analogues alone at getting Crohn's into remission. It may also be better at improving symptoms. The two treatments may be similar in terms of safety. – Infliximab alone may be more effective than purine analogues alone for getting Crohn's into remission and improving symptoms. The two treatments may be similar in terms of safety. – Infliximab may be as effective as the biosimilar at getting Crohn's into...