What are the best ways to help people to stop using smokeless tobacco? Key messages Counselling, brief advice, varenicline and nicotine replacement therapy may all be effective ways to help people quit using smokeless tobacco. We need more research from countries in South and Southeast Asia, where smokeless tobacco is most commonly used and where there are the most different kinds of smokeless tobacco. What is smokeless tobacco? Smokeless tobacco is tobacco that, instead of being smoked in a cigarette or pipe, is used by chewing, sniffing or holding in the mouth. Over 300 million people...

Training to increase parental participation in the care of infants in neonatal units This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of training to increase parental participation in the care of infants in neonatal units, compared to no training or a different type of training. This is a protocol....

What factors influence caregivers’ and adolescents’ views and practices around human papillomavirus (HPV) vaccination for adolescents? Key messages • Many complex factors may influence caregivers’ and adolescents’ views and actions about human papillomavirus (HPV) vaccination for adolescents. We divided them into 8 themes relating to individual knowledge and perceptions, family and social relationships, and the wider contexts in which caregivers and adolescents live. • Healthcare planners and policy-makers could use the themes to help them understand specific contexts in which people are...

Antibiotics to prevent infection after surgery to manage miscarriage Key messages We are uncertain whether routine antibiotics have any effect on the risk of getting a uterine infection (infection in the womb) after surgery to manage a miscarriage, based on the combined results from all six trials. However, based on the results from only the well-done trials (85% of the total number of women in the studies), we are confident that routine antibiotics reduce the risk of getting a uterine infection after surgery to manage a miscarriage. We are uncertain whether routine antibiotics have any...

What are the benefits and risks of different types of surgery for people with presbyopia? Key Messages Based on current evidence, the relative benefits and risks of different types of surgery for treating people with presbyopia (difficulties in reading or seeing close up) are unclear at three to six months after treatment. There was no information about the effects beyond six months after treatment. No study looked at the balance of costs and how well the different treatments worked. Future well-designed studies should measure the longer-term benefits and risks of different types of surgery...

Anti-TIGIT inhibitors plus PD-1 or PD-L1 inhibitors versus PD-1 or PD-L1 inhibitors for first‐line treatment of advanced non-small cell lung cancer This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effectiveness and safety of anti-TIGIT inhibitors in combination with PD-1 inhibitors or PD-L1 inhibitors compared to treatment with PD-1 inhibitors or PD-L1 inhibitors in the first-line treatment of advanced NSCLC. To assess the effectiveness and safety of anti-TIGIT inhibitors in combination with chemotherapy and PD-1 inhibitors or PD-L1...

Exercise for low back pain in adolescents and children This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of exercise compared to placebo/sham/attention control or no treatment for low back pain in adolescents and children. This is a protocol....

Scales to assess pain in newborn infants Key messages Clinical staff should be aware that the available rating scales for assessing pain in newborn infants are of very low quality. There is a need to develop these scales further. What are clinical rating scales? Since newborn infants cannot express their pain with words, staff need to assess their pain by looking at their behaviours and vital signs instead. Many different rating scales can be used for this, assessing infant pain through, for example, heart frequency, facial expression, and body movement. What did we want to find out? We...

Is switching to a different antipsychotic medicine better than continuing with the same one for people with non-responsive schizophrenia? Key messages • We do not know if people with non-responsive schizophrenia have better outcomes if they switch to a different antipsychotic medicine or continue with the same one because the evidence is very uncertain. • The few studies which looked at this question differed markedly from each other in terms of the antipsychotics used, study duration and definitions of initial non-response. • We need further large, well-conducted studies to shed light on...

What are the effects of using a drain compared to no drain after surgical removal of the appendix for treating complicated appendicitis? Key messages • We do not know if drain (tube) use after open (where a large cut is made to access underlying organs or tissues) or keyhole (surgery performed through a very small surgical cut) removal of the appendix has an important effect on the abdominal abscess (collection of pus in the abdomen) rate, wound infection rate, or overall complication rate in children and adults with complicated appendicitis (death, decay, or perforation of the appendix). •...

Music-based interventions for people with chronic kidney disease undergoing haemodialysis This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of music-based interventions on fatigue, blood pressure, depression, pain, anxiety, stress, QoL, and sleep quality in people with CKD receiving HD. This is a protocol....

What medicines are useful to treat myotonia (delayed muscle relaxation after contraction)? Key messages – Mexiletine appears to be safe and is likely an effective treatment for managing symptoms of myotonia (delayed muscle relaxation after a contraction) in people with non-dystrophic myotonia and it probably also slightly reduces myotonia in people with myotonic dystrophy. – Lamotrigine may also reduce myotonia in non-dystrophic myotonia. – More research and larger studies are needed to determine with certainty if lamotrigine is an effective treatment in both myotonic dystrophy and...

Does delaying the initiation or starting calcineurin inhibitors at a lower dose reduce the risk of delayed recovery of a transplanted kidney? Key messages • After kidney transplantation (a surgical procedure where a kidney is transferred from one person - the donor - to another person - the recipient), it may take a few days for the kidney to start working, especially if the kidney donor was older or the kidney was without blood flow for a long time. • The best treatment for people at high risk of this delayed recovery is still unclear. Current options include delaying the use of a...

Closure of defects or non-closure of defects: which works better to prevent internal hernia after bariatric surgery? Review question Does closing defects after Roux-en-Y gastric bypass (RYGB) in bariatric surgery prevent internal hernias? Key messages Due to a lack of evidence, it is unclear whether closing defects is better than not closing defects in preventing internal hernias after bariatric surgery. Closing defects may reduce the number of internal hernias compared to not closing them. Background An internal hernia is a serious problem that can happen after a type of weight-loss surgery...

Which gonadotropins are the best choice to stimulate ovulation in women with polycystic ovary syndrome (PCOS) Key messages In women with polycystic ovary syndrome (PCOS), there may be little or no difference in live birth, multiple pregnancy (twins or triplets), pregnancy, or miscarriage rates between urinary-derived gonadotropins (derived from urine from menopausal women) and recombinant follicle-stimulating hormone (developed with recombinant DNA technology). For human menopausal gonadotropin (also derived from the urine of menopausal women) versus purified urinary follicle stimulating...

Next-generation sequencing (NGS) techniques for pre-symptomatic identification of genetic diseases in newborns This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of using NGS techniques compared to conventional newborn screening alone for pre-symptomatic identification of genetic diseases in newborns. Secondary objectives: to explore equity and ethical issues in the application of the new techniques, to inform healthcare decisions by families, carers, and policymakers. This is a protocol....

Digital tracking, provider decision support systems, and targeted client communication via mobile devices to improve primary healthcare Key messages Using digital tools to help healthcare workers track patient information and make decisions has mixed results. These approaches may lead to benefits in some situations but may make little or no difference in others. We often do not know the full impact because there are not enough studies, or the studies do not provide clear answers. What did we want to find out? This review examined whether digital tools can help healthcare workers collect...

What are the benefits and risks of medications given before surgery to remove non-cancerous growths in the womb (uterine fibroids)? Key messages - Gonadotropin-releasing hormone analogues (GnRHa) are medications that may be able to reduce womb and fibroid size and increase haemoglobin (a protein that helps transport oxygen in red blood cells) levels before surgery to treat uterine fibroids (non-cancerous growths in the womb). Pretreatment with GnRHa may also reduce the time taken to undergo the operation, the need for blood transfusion, and some complications that can occur during or after...

In-hospital motor interventions to reduce neurodevelopmental impairment in preterm infants: a scoping review This is a protocol for a Cochrane Review (prototype). The objectives are as follows: The aim of this scoping review is to map the quantitative literature about in-hospital motor interventions used to reduce neurodevelopmental impairment in preterm infants. We will collate information about the features, delivery mechanisms, objectives, providers, underlying theoretical frameworks, hypothesized or reported outcomes of these interventions, and equity characteristics of the population....

Medical cannabis for the treatment of insomnia This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of medical cannabis on adults with insomnia. This is a protocol....