Is exercise of the pelvic floor muscles more effective for treating unintentional passing of urine (incontinence) in women when feedback or biofeedback are added? Key messages • In women with urinary incontinence (involuntary loss of urine), using a biofeedback device (a device with a sensor that measures muscle contractions and gives audio or visual feedback) with pelvic floor muscle training makes little or no difference to incontinence-related quality of life, how often leakage happens, or how often women feel their symptoms are cured or improved. Most evidence comes from women with...

Do antidepressants help people with non-specific low-back pain and spine-related leg pain? Key messages • Compared with a placebo (inactive or 'dummy' pill), serotonin and norepinephrine reuptake inhibitors (a class of antidepressant) probably provide small reductions in pain intensity and trivial improvements in function in people with low back pain. Some people will probably experience unwanted effects when taking these medicines. • Compared with a dummy pill, tricyclic antidepressants (a class of antidepressant) probably provide small improvements in function in people with low back pain,...

Does music-based therapy help people with dementia? Key messages · Compared to usual care (i.e. without specific activities), providing people with dementia with music-based therapy sessions probably improves depression, and may improve overall behavioural problems. · Compared to other activities, music-based therapy may improve social behaviour, but we are unsure if it improves anxiety. · These effects may not last beyond the end of treatment. · There is no evidence that music-based therapy makes a difference to the emotional well-being, agitation or cognition (e.g. thinking and...

What are the benefits and risks of alternative models of delivering care for people with low back pain? Key messages - Compared to usual care, alternative care models probably do not appreciably improve the quality of care for people with low back pain in terms of referrals to or use of any lumbar spine imaging and prescription or use of opioids. - Alternative care models do not make an important difference to the level of pain or back-related function. - We are less certain of the effects on lumbar spine surgery, hospitalisation, and total adverse (unwanted or harmful) events. What is...

Can vasodilators (medicines that widen blood vessels) help women with infertility have children? Key messages 1. Vasodilators (medicines that widen blood vessels) compared with dummy treatment or no treatment probably help women become pregnant, but probably have side effects. In addition, vasodilators compared with dummy treatment or no treatment, and compared with oestrogens (female sex hormones), may have little or no effect on the chance of women carrying the pregnancy to term and having the baby. 2. To draw more solid conclusions, we need larger, well-designed studies on this treatment....

Blood pressure management in reperfused ischemic stroke This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of intensive systolic blood pressure management (target less than 160 mmHg) versus conventional management (target less than 180 mmHg) in people undergoing ischemic stroke reperfusion via systemic thrombolysis or endovascular thrombectomy. This is a protocol....

Epley maneuver, performed by family doctors or emergency physicians, for benign paroxysmal positional vertigo in adults This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of the Epley maneuver, performed by family doctors or emergency physicians, for adults with benign paroxysmal positional vertigo. This is a protocol....

What are the benefits and risks of different cervical preparation methods for surgical abortion in the second trimester of pregnancy? Key messages • Prostaglandin and osmotic dilators are likely safe and effective methods of cervical priming agents before second trimester surgical abortion. • Misoprostol plus osmotic dilators probably increases pre-procedure cervical dilation and reduces procedure time and need for additional dilation compared to placebo (dummy treatment) plus osmotic dilators. • Overnight laminaria may improve procedure time, pre-procedure dilation, and need for additional...

Are azathioprine and 6-mercaptopurine effective drugs for the long-term treatment of ulcerative colitis? Key messages • Azathioprine and 6-mercaptopurine seem to be more effective than placebo (fake pills) for the long-term treatment of ulcerative colitis, which is an inflammatory disorder of the large bowel. • There is not enough evidence to evaluate the effect of azathioprine or 6-mercaptopurine in combination with other drugs. What is ulcerative colitis, and could azathioprine and 6-mercaptopurine work? Ulcerative colitis is a chronic inflammatory disorder of the large bowel. The rising...

Flu vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions Key messages Offering flu vaccination to people working in care institutions may make little or no difference to the number of residents who get flu or go to hospital with a chest infection, compared to those living in care institutions where no vaccination is offered. Although we found that healthcare worker vaccination programmes led to fewer deaths due to any cause in residents of care institutions, we could not explain these results in terms of the reduction in flu or...

Renin inhibitors or angiotensin receptor blockers: which work better to treat hypertension? Key messages - The available evidence from short-term studies suggests there is probably little to no difference between renin inhibitors and angiotensin receptor blockers in terms of death rates, withdrawal due to unwanted effects, serious unwanted events, unwanted events, and blood pressure control for people with mild primary hypertension. - Due to a lack of strong evidence from long-term studies, any potential differences between these two drugs for measures of heart and blood vessel health are...

What are the benefits and risks of balloon dilatation of the Eustachian tube for obstructive Eustachian tube dysfunction? Key messages Balloon dilatation of the Eustachian tube (BET) probably improves Eustachian tube dysfunction compared to nasal medications up to three months after the procedure. How certain we are about this evidence depends on the length of follow-up and the type of treatment this is compared with. What is Eustachian tube dysfunction? The Eustachian tube is a tube which connects the middle ear (part of the ear behind the ear drum) with the back of the nose. People can...

Efficacy and safety of SARS-CoV-2 vaccination in pregnancy to prevent COVID-19 in mothers and early infancy This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of SARS-CoV-2 vaccination during pregnancy, versus placebo or no vaccination during pregnancy, for preventing COVID-19 disease in mothers and infants. This is a protocol....

What are the best strategies to implement World Health Organization (WHO) recommendations to prevent, detect, and treat postpartum hemorrhage? Key messages Multicomponent implementation strategies may improve adherence to World Health Organization (WHO) postpartum hemorrhage (PPH) prevention recommendations and probably do not make a difference to intensive care unit (ICU) admissions, need for additional surgeries, or death of the mother. We do not know if multicomponent implementation strategies affect blood loss or blood transfusion. We do not know if single-component implementation...

Effectiveness of SARS-CoV-2 testing strategies This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of different SARS-CoV-2 testing strategies in reducing COVID-19 cases, hospitalisations, and deaths among suspected cases and asymptomatic individuals. This is a protocol....

What are the benefits and harms of non-vitamin K antagonist oral anticoagulants (NOACs), the next-generation blood thinners, after transcatheter aortic valve replacement (TAVR)? Key messages • In people who do not have a medical reason to take blood thinners, non-vitamin K antagonist oral anticoagulants (NOACs), specifically rivaroxaban and apixaban, may increase the risk of death for any reason when compared with antiplatelet drugs, while edoxaban appears to have little or no effect. Any differences between rivaroxaban, apixaban, or edoxaban, and antiplatelet therapy in death caused by...

Acupuncture for babies with neonatal abstinence syndrome after exposure to drugs while in the womb Key messages • Due to a lack of evidence, we are unable to draw any conclusions about the benefits and risks of acupuncture for babies with neonatal abstinence syndrome caused by being exposed to drugs while in the womb. • Large studies that are well-designed and reported are needed to find out more about the benefits and risks of acupuncture, including studies that make comparisons of acupuncture techniques, sites, timing and application. What is neonatal abstinence syndrome? Neonatal...

What are the benefits and risks of tumor necrosis factor inhibitors for juvenile idiopathic arthritis? Key messages • When compared to placebo, tumor necrosis factor inhibitors (TNFi) may make young people with juvenile idiopathic arthritis (JIA) feel better overall, but the effects of the medicines on joint function, pain, disease control, and harm are uncertain. • We are uncertain about the benefits and harms of TNFi when compared to another medicine called methotrexate. • More high-quality studies are needed to understand the benefits and harms of TNFi in JIA. What is juvenile idiopathic...

Does cardiovascular training relieve cancer-related fatigue before, during, or after anticancer therapy? Key messages Cardiovascular training during anticancer therapy probably reduces cancer-related fatigue slightly for up to 12 weeks. The longer-term effects of cardiovascular training on cancer-related fatigue and quality of life are uncertain and there is no evidence about the effects of cardiovascular training before anticancer therapy. We found nearly 50 studies of cardiovascular training before, during, and after cancer treatment that are underway and these will add to the evidence...

How accurate is carbon dioxide detection in establishing if a tube inserted through the nose or mouth has been accidentally placed in the airway instead of the stomach in children? Key message • There is not enough evidence to suggest that carbon dioxide (CO₂) testing should be added to current checking procedures. • More studies are needed to determine if CO₂ testing is beneficial for children undergoing insertion of an enterogastric tube. Why is it important to know if the tube is accidentally placed in the airway? The insertion of a thin, flexible plastic tube through the nose or mouth...