Paschoalini 2005.

Methods	Two‐centre, prospective RCT of silver nitrate vs talc slurry in MPE (Brazil)
Participants	Inclusion: documented MPE (positive pleural biopsy or cytology ‐ all cell types); karnofsky performance score > 60; life expectancy > 1 month Exclusion: loculated or trapped lungs after drainage 60 participants randomised
Interventions	26/28 Fr chest tube. After study drug instilled, clamped for one hour with patient rotation. Then suction applied. Drain removed when < 100 ml drained Talc group: 5 g talc in 50 ml saline. 1 dose intrapleurally Silver nitrate group: 20 ml of 0.5 ml silver nitrate. 1 dose intrapleurally
Outcomes	Radiological resolution of effusion on CXR (monthly for four months) Pain before and after treatment (measured on a 0‐10 linear scale)
Notes	People with trapped lung excluded from study entry Not included in network meta‐analysis
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Picking paper from a box
Allocation concealment (selection bias)	Low risk	Picking paper from a box
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not stated if blinded but agents have different appearances
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated if CXR interpretation was blinded. Pain scores may be biased if participants not blinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	High rate of LTFU (11/60 (18%)) but reasons explored in the discussion
Selective reporting (reporting bias)	Low risk	All stated outcomes reported
Other bias	Low risk	No other biases identified