Does using hormonal contraception increase a woman's risk of gettingHIV? Does using hormonal contraception increase a woman's risk of getting HIV? Key messages DMPA (depot medroxyprogesterone acetate) injections likely result in little to no difference in the risk of getting HIV compared to the copper intrauterine device (IUD). The levonorgestrel implant (LNG) likely results in little to no difference in the risk of getting HIV compared to the copper IUD. DMPA injections likely slightly increase the risk of getting HIV compared to LNG implants. We are not certain about the effect of...

Does community care navigation (where a clinician helps guide patients through healthcare systems) reduce unplanned hospitalisations for ‘at-risk’ individuals? Key messages • People who receive community care navigation assistance are probably slightly less likely to be admitted to hospital for unplanned reasons in the first year after care navigation than those who do not receive this type of assistance. • We need more studies, with better reporting, to identify the types of people, settings and ways of delivering community care navigation that are likely to deliver the most benefit and to...

What are the benefits and harms of corticosteroids in the treatment of children and adults with sepsis? Key messages • Compared to placebo or usual care, corticosteroids probably reduce the risk of death at 28 days and of in-hospital death, and may have little or no effect on the risk of dying beyond three months. • We are uncertain about the effects of continuous intravenous infusion of corticosteroids compared with intermittent intravenous bolus (rapid injection) administration. • Future studies should measure the benefits and harms of corticosteroids for the treatment of specific...

Are there differences in benefits and harms among regional pain management techniques in women undergoing breast cancer surgery? Key messages Overall, we found that different pain blocks were similar for managing pain after breast cancer surgery. Complication rates were low among all pain block techniques. What is regional analgesia, and how does it work? Regional analgesia is a pain block technique used in breast cancer surgery. It involves injecting pain-numbing medicine near specific nerves in the breast area to block pain signals during and after surgery. Unlike opioids, which affect the...

Immunomodulators and immunosuppressants for myasthenia gravis: a network meta‐analysis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary To assess the comparative benefits and harms of immunomodulators and immunosuppressants for people with generalised myasthenia gravis through a network meta-analysis. Secondary To estimate the relative ranking of immunomodulators and immunosuppressants according to their effects. This is a protocol....

Is the use of telemedicine services for medical abortion better than in-clinic care? What is medical abortion care? A medical abortion is an abortion where a person ends a pregnancy using a combination of two types of medication, mifepristone and misoprostol, or by using misoprostol alone. Medical abortion care comprises three different phases: pre-abortion, abortion, and post-abortion. These phases include different care components. The pre-abortion phase includes pre-abortion information, counselling, if desired, and eligibility assessment. The abortion phase includes instructions for,...

Which combinations of ways to diagnose and treat excessive bleeding after childbirth (postpartum haemorrhage) are most effective? Key messages We found the combination of using a diagnosis with 1) birth-attendant clinical concern, or 2) 300 mL to 500 mL of drape-measured blood loss (blood is collected in a plastic drape with markings indicating the volume) with observations (e.g. heart rate, blood pressure, the tone of the womb, and flow of blood), or 3) 500 mL or more of drape-measured blood loss to diagnose postpartum haemorrhage (PPH), plus a treatment bundle, was more effective than...

What is the best approach to prepare women's womb lining for frozen-thawed embryo transfer? Key messages • We did not find sufficient evidence to support the use of one cycle regimen (approach) over another in preparation for frozen-thawed embryo transfer (FET) in women with regular ovulatory cycles who have difficulty getting pregnant (subfertile women). • Larger, well-conducted studies are needed, particularly those that investigate the simpler or cheaper frozen-thawed embryo transfer approaches. What is frozen-thawed embryo transfer (FET)? In subfertile women undergoing assisted...

Exercise interventions for the treatment of lower limb lymphoedema after treatment for gynaecological cancers This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of load exercise therapy with complex decongestive therapy compared with complex decongestive therapy alone for lower limb lymphoedema after gynaecological cancer treatment. This is a protocol....

Community-based interventions for the prevention or management of dental caries in children This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To undertake network meta-analysis (NMA) and component network meta-analysis (CNMA) to explore the comparative effectiveness of different community-based interventions, and the components within the interventions used singly or in combination, for the prevention or management of dental caries in children. This is a protocol....

What is the best treatment for complex abdominal aortic aneurysms? Key messages • There are currently no studies with information available to guide patients' and doctors' choices regarding treatments for complex abdominal aortic aneurysms (AAAs). • It is difficult to conduct research in this area because relatively few people have this condition and the types of aneurysm they have vary. • Future research should explore how organisations that fund and oversee healthcare services could require or promote the inclusion of people with AAAs in studies testing different treatments. What is an...

What are the most accurate tests for diagnosing low vitamin A? Key messages • The two most common tests (serum or plasma retinol and retinol-binding protein) cannot reliably identify at-risk individuals with or without vitamin A deficiency in the community or clinics. • This may mean that using these tests could lead to over- or underestimated levels of low vitamin A at the population level and incorrect diagnosis of individuals. • Estimates of test accuracy should improve as more studies become available. Why is it important to improve screening for vitamin A? Vitamin A, also called...

Do epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) after lung cancer surgery help people live longer and prevent cancer from returning? Key messages • Taking EGFR TKIs after lung cancer surgery may help people stay cancer-free for longer than chemotherapy or no further treatment. • EGFR TKIs probably help people live longer compared to no treatment, but may make little to no difference in survival compared to chemotherapy. • EGFR TKIs have fewer serious side effects than chemotherapy, but they may cause more mild-to-moderate side effects. • More research is needed...

Does yoga relieve cancer-related fatigue in people with cancer? Key messages - Compared to no yoga, yoga after anticancer therapy probably reduces cancer-related fatigue slightly in the short term (up to 12 weeks after doing yoga). - We do not know if yoga during anticancer therapy relieves short-, medium-, or long-term cancer-related fatigue compared to no yoga. - More research is needed to understand (1) if the effects of starting yoga after anticancer therapy persist beyond 12 weeks, and (2) what are the effects of doing yoga before starting and during cancer treatment. What is...

Is post-incident debriefing after coercive measures for people with schizophrenia effective? Key messages • Due to a lack of evidence, the benefits of post-incident debriefing after coercive measures (seclusion: locking someone in a separate room, or restraint: preventing them from moving) for people with schizophrenia or schizophrenia-type psychosis are unclear. • Future research is needed into the effects of post-incident debriefing after coercive measures to find out whether it has benefits for people with schizophrenia and whether it has unwanted effects and costs. What is schizophrenia,...

Community health worker-led interventions for hypertension This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of community health worker-led interventions on controlling blood pressure for people with hypertension. This is a protocol....

Do strengthening exercises help in the treatment of people with patellar tendinopathy (jumper's knee)? Key messages — The evidence for using strengthening exercises to treat patellar tendinopathy (pain at the front of the knee involving the tendon) is very uncertain, making it difficult to draw firm conclusions. — For athletes, we are very uncertain whether exercise reduces pain compared to no treatment. Strengthening exercises may make little or no difference to function compared to no treatment, and little or no difference to function and pain compared to glucocorticoid injections...

Is it better to use ultrasound or anatomical landmarks to guide the needle to the correct placement for anaesthesia around the spinal cord in adults? Key messages Compared to anatomical landmarks, using ultrasound guidance for neuraxial anaesthesia in adults reduces the number of attempts until success, and the procedure (needling) time. Success is defined as either the number of times the needle is advanced following a backward movement, or the number of times it punctures the skin. Ultrasound guidance likely increases the rate of success on the first try. Ultrasound guidance may make...

What are the benefits and risks of vaccines for preventing infectious diseases in adults with blood cancers? Key messages • We found limited evidence on the preventive effect of vaccines on patient-relevant outcomes in adults with blood cancers. The included studies focused only on herpes zoster, COVID-19, and influenza vaccines. No studies measured quality of life. • When compared to placebo, herpes zoster vaccines may lower the incidence of infection. They probably result in little to no difference in death from any cause. They cause short-term side effects, but we did not find an increase...

Are atypical antipsychotic medicines useful for treating irritability and other symptoms in people with autism? Key messages Risperidone and aripiprazole may reduce irritability symptoms, while lurasidone probably results in little to no difference in children with autism. There is significant uncertainty about the effects of these drugs on aggression, weight gain and abnormal body movements (e.g. tremors) in children with autism. These medicines may decrease obsessive-compulsive symptoms (unwanted thoughts (obsessions) and repetitive behaviours (compulsions)) and inappropriate speech in...