Mohsen 2011.

Methods	Single Centre RCT of thoracoscopic talc poudrage versus povidone‐iodine pleurodesis through an intercostal drain (Egypt)
Participants	Inclusion: MPE as a complication of breast carcinoma Exclusion: performance status > 3; allergy to iodine; trapped lung; no change in MRC dyspnoea scale after thoracentesis; pleural fluid pH < 7.2; pleural fluid glucose < 60 mg/dl; extrathoracic metastasis 42 participants randomised
Interventions	All participants underwent a VATS drainage and adhesiolysis Talc poudrage group: 4 g talc insufflation under thoracoscopic guidance at the end of the VATS procedure Iodine group: recovered from VATS. Then later that day, 20 ml 10% povidone‐iodine in 30 ml saline injected through the chest drain at the bedside. Drain clamped for four hours after instillation
Outcomes	Efficacy of pleurodesis at two months (response defined as 'complete response' (CR) (absence of fluid re‐accumulation), 'partial response' (PR) (residual pleural fluid or re‐accumulation, which did not require further thoracocentesis or remained asymptomatic) or 'failure' (additional pleural procedures were necessary) Complications Length of hospital stay (in days) Survival Change in MRC dyspnoea score
Notes	People with trapped lung excluded from trial entry CR + PR counted as pleurodesis success for analysis Included in network meta‐analysis for pleurodesis efficacy, mortality and fever
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer randomisation software used
Allocation concealment (selection bias)	Low risk	Computer randomisation software used
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not able to blind given the nature of the interventions
Blinding of outcome assessment (detection bias) All outcomes	High risk	Symptom and side effect reporting would be effected by lack of blinding. Not stated if radiology was interpreted blindly. Mortality would not be biased by lack of blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	Minimal missing data (primary outcome data available for all patients at two months)
Selective reporting (reporting bias)	Low risk	All stated outcomes reported
Other bias	Low risk	No other biases identified