Does giving a probiotic supplement to infants reduce allergies? Key messages Probiotics (live bacteria that provide health benefits to the digestive tract) given to newborns as a supplement or added to infant formula in the first six months of life may slightly reduce the development of eczema (dry, itchy and inflamed skin) in infants by the age of two years, but there are not enough good-quality studies to be certain about the result. Probiotics may have little to no effect on the development of allergic diseases such as asthma (a respiratory condition with symptoms like cough, wheezing,...

What are the benefits and risks of different ways of accessing the hip joint during partial hip replacement surgery? Key messages The evidence is still developing, and future studies may change our conclusions. We are not confident that one surgical approach (way of accessing the hip joint) compared to another leads to a different outcome for performing daily tasks, health-related quality of life, mobility or functional status, mortality, or pain, within the first four months after surgery. What is hip hemiarthroplasty? Hip hemiarthroplasty, or partial hip replacement, is surgery that...

Do programs with multiple behavioral components improve the regular usage of eye pressure-lowering medications in people with glaucoma? Key messages Multifaceted behavioral programs that are intended to improve regular usage of eye pressure-lowering eye drops in people with high eye pressure or diagnosed with glaucoma can include a combination of reminders, multimedia education, in-person education, dosing aids, mindfulness-based stress reduction, monetary incentives, simplification of drop regimen, and doctor education. How well these programs work is unclear; some data show favorable...

Does using multiple tests in combination ('parallel testing') result in better accuracy for detecting TB in the lungs (pulmonary tuberculosis) in children than using a single test? Key messages - Using both respiratory samples and stool for low-complexity automated testing (LC-aNAATs) increased the number of pulmonary tuberculosis cases detected in children (with and without HIV). - Adding the lateral flow urine lipoarabinomannan test (LF-LAM) identified additional pulmonary tuberculosis cases in children with HIV. - Parallel testing may lead to more misdiagnoses of children who do...

Are progestogen medications beneficial for preventing recurrent miscarriage? Key messages Giving progestogen medication likely makes little to no difference to the chances of miscarriage or live birth for women who have previously had miscarriages for no known reason. What is recurrent miscarriage? Early pregnancy loss, also known as miscarriage, generally occurs in the first trimester (the first 13 weeks of pregnancy). For some women and their partners, miscarriages can happen several times. This is also known as having recurrent miscarriage. While there are sometimes causes found for...

Are antiplatelet treatments or anticoagulation treatments better for people who have heart failure with a normal heart rhythm? Key messages – For people who have heart failure with a normal heart rhythm, there seems to be little to no advantage of warfarin (an anticoagulant: a medicine which prevents blood clotting by blocking proteins) over antiplatelet medicines like aspirin (which prevent blood clotting by blocking platelets). – Treatment with warfarin leads to more bleeding problems than aspirin or clopidogrel. How do anticoagulant and antiplatelet treatments help people with heart...

Do dietary and activity strategies help prevent obesity in children aged 2 to 4 years? Key messages Combining strategies for changing diet and physical activity levels in children aged 2 to 4 years to help prevent overweight and obesity may reduce body mass index (BMI) slightly in the long term (after 15 months). There was very little information about whether the strategies resulted in serious adverse events (e.g. injuries), but none of the strategies appeared to result in any serious harm to the children. Future research should carry out obesity prevention strategies in community settings,...

In adults and adolescents with HIV, is using two different rapid tests together ('parallel testing') to diagnose tuberculosis (TB) disease more accurate than using only one? This review looked at adults and adolescents with HIV who have signs and symptoms of tuberculosis (TB) disease. Diagnosis can be done using respiratory samples (fluids or mucus collected by coughing or using tubes to remove fluid from the throat, lungs, or stomach) or urine. We wanted to know whether using two rapid tests together - an automated test on a respiratory sample (LC-aNAAT) and a urine strip test...

Does removing more or fewer lymph nodes improve outcomes in women who have endometrial cancer? Key messages Not removing pelvic lymph nodes (which are part of the immune system and in the lower tummy) probably does affect survival compared with removing all pelvic lymph nodes in women without obvious disease spread and may reduce the risk of disease coming back. Not removing pelvic lymph nodes, or removing only the first draining lymph nodes (called sentinels), probably greatly reduces the risk of developing swelling in the legs after surgery compared with removing all pelvic nodes, or...

Gonadotropin-releasing hormone (GnRH) analogues for treating premenstrual syndrome (PMS) Review question What are the benefits and risks of using medication known as gonadotropin-releasing hormone (GnRH) agonists and antagonists in the management of premenstrual syndrome (PMS)? Key messages • We found reliable evidence that GnRH agonists without add-back improve PMS symptoms compared to placebo, but also that menopausal side effects are common, and women taking GnRH agonists without add-back are more likely to stop their treatment than women taking placebo. • We are moderately confident that...

Which is safer after removing the tail of the pancreas: stapler or handsewn closure? Key messages • There is likely little or no difference in leaks from the pancreas (pancreatic fistula) and may be little or no difference in deaths after surgery, whether the pancreas is closed with a stapler or sewn by hand. • Surgeons may choose the method they are more comfortable with or that best suits the patient’s situation. • More research should focus on other ways to prevent leaks after pancreas surgery, as the best method is still not known. What is the pancreas, and why is it removed? The...

Do antibiotics taken orally or given as an injection help people with chronic suppurative otitis media? Key messages - We do not know if antibiotics taken by mouth or given as an injection (systemic antibiotics) are effective treatments for chronic suppurative otitis media (CSOM; a type of long-term ear infection), and whether they lead to unwanted effects. Evidence about unwanted effects is particularly limited. - Future studies should be larger, use rigorous methods, include groups at particular risk of CSOM, follow participants for at least six months, and assess outcomes that are...

What are the benefits and harms of using topical antibiotics to treat chronic suppurative otitis media? Key messages – We are uncertain whether topical antibiotics reduce ear discharge of people with swelling and infection of the middle ear (called chronic suppurative otitis media). – Topical antibiotics may reduce ear discharge compared to placebo (a salt solution), but we are very uncertain. Topical antibiotics used in addition to an antibiotic given by mouth may reduce ear discharge. – Overall, we are very uncertain which type of topical antibiotic is the most effective. What is chronic...

Which are better, antibiotics or topical antiseptics, for treating chronic suppurative otitis media? Key message – There is limited evidence comparing topical antibiotics with topical antiseptics in people with swelling and infection of the middle ear (called chronic suppurative otitis media). The evidence is very uncertain whether antibiotics or topical antiseptics are more effective for reducing ear discharge, except that topical antibiotics are likely to be more effective than boric acid (an antiseptic). What is chronic suppurative otitis media? Chronic suppurative otitis media is a...

What are the benefits and harms of ear cleaning to treat inflammation and infection of the middle ear? Key messages – We do not know how effective ear cleaning is for people with inflammation and infection of the middle ear (called chronic suppurative otitis media), and whether it causes unwanted effects. – We are very uncertain about the evidence within the very few studies on this topic. Unwanted effects were not well reported in the studies we found. We need researchers to conduct studies that compare ear cleaning to no cleaning, and compare different cleaning techniques and frequency, so...

Benefits and risks of combining local antibiotics and steroids to treat chronic suppurative otitis media Key messages - We are uncertain about the effectiveness of topical (i.e. delivered as drops, sprays or creams) antibiotics with steroids for improving the resolution of ear discharge in participants with an ear condition known as chronic suppurative otitis media (CSOM). - We found no evidence that the addition of steroids to topical antibiotics affects the resolution of ear discharge when measured at one to two weeks, and no results were available for longer-term outcomes. - There is...

What are the benefits and risks of topical antiseptics for treating long-term middle ear infection (chronic suppurative otitis media)? Key messages • Due to a lack of studies, we are very uncertain of the benefits and risks of topical antiseptics in the treatment of chronic suppurative otitis media (long-term middle ear infection). • We need more information about possible harmful effects of topical antiseptics, as these were not well reported in the studies. What was studied in the review? Chronic suppurative otitis media (CSOM) is a long-term (chronic) swelling and infection of the middle...

What are the benefits and harms of antibiotics given directly into the ear compared to antibiotics given to the whole body to treat chronic suppurative otitis media? Key messages – Topical quinolone antibiotics (given directly into the ear) may be slightly more effective than systemic antibiotics (given to the whole body) at resolving ear discharge. – We do not know whether topical or systemic antibiotics are better for improving hearing. What is chronic suppurative otitis media? Chronic suppurative otitis media, also known as chronic otitis media, is an inflammation and infection of the...

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...