Yim 1996.

Methods	Single centre RCT of talc insufflation versus talc slurry for symptomatic MPE (Hong Kong)
Participants	Inclusion: established, symptomatic MPE (all cell types); dyspnoea improved after tube thoracostomy or large volume thoracentesis Exclusion: Karnofsky score < 30%; FEV1 < 0.5 L; trapped lung; chemotherapy or radiotherapy within six months 57 participants randomised
Interventions	Talc insufflation group: all participants underwent a GA with one lung ventilation in the lateral decubitus position. 10 mm port inserted. Adehsions and loculations broken down. 5 g talc insufflated into the chest. 28 Fr tube at end of procedure, connected to suction. Drain removed when < 50 ml/24 hours drainage Talc slurry group: chest tube. 5 g talc in 50 ml saline and 10 ml 2% lidocaine instilled through the drain. Drain clamped for two hours and participant turned Drain reconnected to suction and removed when output < 50 ml/24hours
Outcomes	Radiological recurrence of effusion Complications of the procedure Post‐procedure chest drain duration Length of hospital stay Parenteral meperidine use
Notes	People with trapped lung excluded from trial entry Included in network meta‐analysis for pleurodesis efficacy and mortality
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding of participants and personnel (performance bias) All outcomes	High risk	Unable to blind due to nature of the interventions
Blinding of outcome assessment (detection bias) All outcomes	High risk	Adverse event reporting and length of stay may be biased by lack of blinding. Not stated whether radiology was reported blindly
Incomplete outcome data (attrition bias) All outcomes	Low risk	All data reported. Survial data not entirely clear
Selective reporting (reporting bias)	Low risk	All outcomes reported on
Other bias	Low risk	Unclear how many patients in the poudrage arm had a drain in situ at the time of trial entry. Pleurodesis success only defined using radiology