Dexmedetomidine for analgesia and sedation for procedural pain or discomfort in newborn infants This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of dexmedetomidine compared with opioids, non-opioids and placebo in providing sedation and analgesia for procedural pain in newborn infants. This is a protocol....

Is continuing chronic blood thinners better than stopping them near or during surgical heart rhythm device implantation? Key message Stopping blood thinners before or during surgery for a CIED may result in little to no difference in undesirable outcomes such as blood clots or bleeding events when compared to taking them continuously. What are cardiac implantable electronic devices? Sometimes, people's hearts do not beat at a normal rhythm. This can make it hard for the heart to pump blood to the rest of the body. It can also increase the chance of getting blood clots. To fix this problem,...

Direct factor Xa inhibitors or classic 'blood thinners': which leads to better outcomes for people undergoing major hip or knee surgery? Key messages • We do not know if classic anticoagulant medicines (commonly known as 'blood thinners') or newer blood-thinning medicines called 'direct factor Xa inhibitors' (DFXa inhibitors) are better at preventing death or the development of blood clots in the deep veins of the legs or in the lungs of people who have had hip or knee replacement surgery. • Compared to classic anticoagulants, DFXa inhibitors may slightly reduce the number of...

What are the benefits and risks of using caesarean myomectomy in pregnant women with fibroids in the womb? Key messages The evidence is very uncertain about the effect of caesarean myomectomy (surgery to remove uterine fibroids, which are non-cancerous growths) on the requirement for blood transfusion, risk of bleeding, length of hospitalisation, length of operation, risk of major surgery, and risk of postpartum fever (high temperature in the days following delivery), so it is not possible to generate any meaningful conclusions. The authors do not know the effect of caesarean myomectomy on...

Individualized developmental care interventions for promoting development and preventing morbidity in preterm infants This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of individualized developmental care interventions for promoting development and preventing morbidity in preterm infants. This is a protocol....

Graded activity for acute and subacute low back pain This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of graded activity compared to placebo, sham, or no treatment, on pain and function in adults with acute and subacute non-specific low back pain. This is a protocol....

Do interventions to help adults stop smoking cigarettes work differently depending on people’s socioeconomic background? Key messages • We have little or no confidence in the evidence for all treatments. This means there is no clear evidence to support using different stop-smoking interventions for people from lower versus higher socioeconomic groups, or that any one intervention would have an effect on health inequalities. However, this conclusion may change as more research becomes available. • More studies that report quit rates by socioeconomic status for each study group are needed....

Does alendronate help prevent fractures caused by osteoporosis in postmenopausal women? Key messages • Alendronate used for up to five years may prevent spinal fractures in women who are at lower risk for fractures, or in those who have not yet had a fracture of the spine. • Alendronate used for up to three years in women diagnosed with osteoporosis, with low bone density, or who have already had a fracture of the spine, probably prevents fractures of the spine. What is osteoporosis? Osteoporosis is a disease which makes bones weak and fragile. Bone is living tissue that is constantly being...

Do intravenous antibiotics improve pulmonary exacerbations (flare-ups) in people with cystic fibrosis? Key messages – Intravenous (given into a vein) antibiotics are commonly used to treat flare-ups in symptoms of cystic fibrosis, but the assumption that exacerbations are due to more bacteria in the lungs has been questioned. – We assessed many different antibiotics as single medicines or combinations of medicines as well as how they were given (intravenous, inhaled (breathed in) or oral (by mouth)). We found no difference in any clinical outcomes such as how well the lungs work or the time...

Lurasidone or typical antipsychotics: which works better to treat schizophrenia? Key messages • We compared lurasidone, a newer antipsychotic, with traditional antipsychotics like haloperidol to treat schizophrenia. • Based on two studies, we are uncertain whether lurasidone improves schizophrenia symptoms or causes fewer unwanted effects compared to traditional medications. • More research is needed to determine the benefits and potential harms of lurasidone in managing schizophrenia. What is schizophrenia? Schizophrenia is a condition that affects how a person perceives reality, leading to...

How accurate are tests that diagnose excessive bleeding (postpartum haemorrhage) after women give birth vaginally? Key messages • Our study found that using visual estimation to diagnose postpartum haemorrhage (PPH) was inaccurate. Using a plastic drape to collect and measure the volume of blood loss – alongside observations including heart rate, blood pressure, tone of the womb, and flow of blood – showed high accuracy. • Other tests, including blood tests and measurements such as heart rate and blood pressure alone, showed varying levels of accuracy. What is postpartum haemorrhage (PPH)?...

Thrombolysis (giving a drug that dissolves blood clots) for aneurysmal subarachnoid haemorrhage (a type of brain bleed) Key messages - Thrombolysis (giving a drug that dissolves blood clots) may improve some outcomes following aneurysmal subarachnoid haemorrhage (a type of brain bleed). For example, it probably reduces the risk of a poor functional outcome (severe disability), probably reduces the risk of cerebral artery vasospasm (a condition where brain arteries constrict, often causing brain damage by reducing blood flow), and may reduce the risk of delayed cerebral ischaemia (a clinical...

Can calorie (energy) labelling change people's selection and consumption of food or alcohol? Key messages – Current evidence suggests that calorie (energy) labelling on menus, and on or next to products, leads to reductions in calories selected and bought from food and non-alcoholic drinks. The evidence for consumption (eating) suggests a similar effect, but there is less evidence and it is of lower quality. – There is insufficient evidence to estimate the effect of calorie labelling for alcoholic drinks. – Calorie labelling of food could lead to potentially meaningful impacts on...

Transtracheal ultrasound for identifying endotracheal intubation in adults This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the diagnostic accuracy of transtracheal ultrasound for detecting endotracheal intubation in adult patients. Secondary objectives Secondary objectives include assessing the diagnostic accuracy of transtracheal ultrasound amongst the following subgroups: setting (e.g. prehospital, emergency department, intensive care unit, operating room) operator specialty (e.g. emergency medicine, non-emergency medicine) operator...

Ankle-foot orthoses to improve walking in people with weakness of the calf muscles due to neuromuscular disorders Key messages Ankle-foot orthoses (AFOs) may reduce the effort required to walk, and increase walking speed and satisfaction with walking in people with calf muscle weakness due to neuromuscular disorders, but we are uncertain about these results. We are unable to draw any conclusions about the effect of AFOs on perceived walking effort, balance, AFO use, and adverse effects. The evidence suggests effects on walking improvement may vary depending on the material from which the AFO...

What are the benefits and risks of tranexamic acid for preventing heavy bleeding after vaginal birth? Key messages Tranexamic acid given as a preventive treatment makes little to no difference to heavy bleeding after vaginal birth. We are uncertain about whether there are any harmful effects from tranexamic acid. What is the issue? Postpartum haemorrhage, which is heavy bleeding after giving birth, is a common and potentially life-threatening complication of birthing a child. Most women receive drugs (called uterotonics) that stimulate the womb to contract after a normal (vaginal) delivery...

Does pre-emptive treatment with antiviral agents help to reduce the risk of cytomegalovirus disease in transplant recipients? Key messages • Cytomegalovirus (CMV, herpes virus related to chickenpox) is a common virus, with the majority of people being exposed by adulthood. CMV is a major cause of illness and death during the first year after transplantation. Prevention strategies include 1) giving daily low doses of an antiviral agent to all organ transplant recipients (prophylaxis) or 2) prescribing an antiviral agent when an organ transplant recipient develops laboratory-confirmed evidence...

Can rewards help people quit smoking, and do they work in the long term? Key messages • Smoking is the leading preventable cause of ill health and early death worldwide. Quitting smoking is vitally important to help people live in good health for longer. • Rewards help people to quit smoking for at least six months. • This effect continues after rewards have ended, suggesting long-term benefits. • Rewards also help pregnant people who smoke to quit smoking. This effect continues after the baby has been born. What are rewards? Incentives, such as money, vouchers or deposits, can be used to...

Do programmes offered through sporting organisations promote healthy behaviour and improve people's health? Key messages • Sporting organisation programmes probably lead to people being slightly more physically active. • Sporting organisation programmes may make little or no difference to the amount of time people are inactive (sedentary). They may increase the amount of fruits and vegetables people eat. • We do not know if sporting organisation programmes make any difference to how many sugary drinks and alcoholic drinks people have, or their tobacco use, as the evidence is very...

Is keeping the azygos vein intact during surgery for newborns with esophageal atresia beneficial? Key messages - Current evidence suggests that preserving the azygos vein during surgical repair for esophageal atresia may result in a reduction in the risk of death, serious complications, leakage from the esophageal repair site (anastomosis leakage), and severe infections or chest infections, when using the open chest surgery (thoracotomy) approach. - Further research is still needed as the results of this review may not be applicable to all newborns with congenital esophageal atresia. What is...