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The scope of this guideline is the assessment, imaging and early management of spinal injury and does not address rehabilitation. It is important to recognise that early management is intrinsically connected to rehabilitation and some later complications may be avoided with changes in early care. Early and ongoing collaborative multidisciplinary care across a trauma network is vital in ensuring that the patient with a spinal injury receives the best possible care.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016

It is difficult to know what the true incidence of metastatic spinal cord compression (MSCC) is in England and Wales because the cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Ontario, Canada, suggests that the incidence may be up to 80 cases per million population per year. This would mean around 4000 cases per year in England and Wales or more than 100 cases per cancer network per year.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: November 2008

This guideline covers the assessment and management of low back pain and sciatica in adults over the age of 16 years.

NICE Guideline - National Guideline Centre (UK).

Version: November 2016

This report assesses different diagnostic imaging techniques (magnetic resonance tomography, positron emission tomography, and positron emission tomography with computed tomography to assess local tumour extent, i.e. whether it is limited to the prostate gland itself, or if it has grown outside the prostate gland (T stage), or spread to the nearby lymph nodes (N stage).

Swedish Council on Health Technology Assessment (SBU).

Version: September 2014

Liver cancer is a leading cause of death among people with chronic hepatitis B infection. Screening such patients with ultrasound of the liver or alpha‐foetoprotein in the blood, or both, is widely performed to detect liver cancer at an early stage. The hope is that early stages of liver cancer can be treated by resection or transplantation, or both, with improved outcomes. Only three trials could be included in this review. One of these trials was conducted in Shanghai, China. It compared screening twice yearly with ultrasound and alpha‐foetoprotein against no screening. The trial has a high risk of systematic errors (bias) and several published reports of the trial provide different results. Another trial was conducted in Toronto, Canada. It compared screening with alpha‐foetoprotein and ultrasound versus screening with alpha‐foetoprotein alone. This trial had too few participants. As there were no participants who were not screened, we cannot assess whether screening is effective in reducing mortality. The remaining trial was published as an abstract only. It was designed to determine the optimal time interval for screening using alpha fetoprotein and ultrasound. The cumulative four‐year survival was not significantly different between the two studied screening intervals of four months and 12 months. Thus, to date, there is insufficient evidence regarding screening for liver cancer among patients with chronic hepatitis B infection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Heavy alcohol consumption causes alcoholic liver disease and may lead to a number of other concomitant diseases. Alcohol may damage the function of body organs and can cause cancer. Liver damage due to excessive alcohol consumption is usually presented as fatty liver (build‐up of fats in the liver), steatohepatitis (inflammation of the liver with concurrent fat accumulation in the liver), fibrosis (fibrous degeneration), alcoholic cirrhosis (scarring of the liver), and hepatocellular carcinoma (most common type of liver cancer). When liver fibrosis progresses, alcoholic cirrhosis occurs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Two of the five guidelines in the NICE trauma suite relate to fractures. These are titled non-complex and complex fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016

Study assessing the diagnostic accuracy of magnetic resonance spectroscopy (MRS) and enhanced magnetic resonance imaging (MRI) techniques in aiding the localisation of prostate abnormalities for biopsy found that MRS had higher sensitivity and specificity than T2-weighted magnetic resonance imaging (T2-MRI) but produced no definitive conclusions on the cost-effectiveness of using different MRS/MRI sequences.

Health Technology Assessment - NIHR Journals Library.

Version: May 2013

Women with endometriosis have endometrial tissue (the tissue that lines the womb and is shed during menstruation) growing outside the womb within the pelvis, causing chronic abdominal pain and difficulty conceiving. Currently, the only reliable way of diagnosing endometriosis is to perform laparoscopic surgery and visualise the endometrial deposits inside the abdomen. Because surgery is risky and expensive, imaging tests have been assessed for their ability to detect endometriosis non‐invasively. An accurate imaging test could lead to the diagnosis of endometriosis without the need for surgery, or it could reduce the need for surgery, so only women who were most likely to have endometriosis would require it. Furthermore, if imaging tests could accurately predict the location of endometriotic lesions, surgeons would have the information they need to plan and improve their surgical approach. Other non‐invasive ways of diagnosing endometriosis by using urine, blood and endometrial and combination tests have been evaluated in separate Cochrane reviews from this series.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Medical treatments for inevitable miscarriage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Most babies in high‐income countries grow well in the womb. However, when the mother has a medical problem such as diabetes, high blood pressure, heart or kidney problems, or the placenta does not develop properly, this may affect the growth of the baby. Also, sometimes babies do not grow well for reasons we do not fully understand. Babies with poor growth are more likely to have complications, resulting in babies being ill or dying. Doppler ultrasound detects changes in the pattern of blood flow through the baby's circulation. These changes may identify babies who have problems.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 13, 2017

One of the main aims of routine antenatal care is to identify mothers or babies at risk of adverse outcomes. Doppler ultrasound uses sound waves to detect the movement of blood in blood vessels. It is used in pregnancy to study blood circulation in the baby, the mother's uterus and the placenta. If abnormal blood circulation is identified, then it is possible that medical interventions might improve outcomes. We set out to assess the value of using Doppler ultrasound of the mother's uterus or placenta (utero‐placental Doppler ultrasound) as a screening tool. Other reviews have looked at the use of Doppler ultrasound on the babies' vessels (fetal and umbilical Doppler ultrasound). We also choose to look at women with low‐risk and high‐risk pregnancies, and in their first or second trimesters. This screening offers a potential for benefit, but also a possibility of unnecessary interventions and adverse effects. The review of randomised controlled trials of routine Doppler ultrasound of the uterus or placenta identified two studies involving 4993 women. All the women were in the second trimester of pregnancy and at low risk for hypertensive disorders. The studies were of good quality but small in size. We identified no improvements for the baby or the mother. However, more data would be needed to show whether maternal Doppler is effective, or not, for improving outcomes. We did not find any studies in the first trimester of pregnancy or in women at risk of high blood pressure disorders. More research is needed on this important aspect of care.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Vascular access is required for people on haemodialysis to connect with the dialysis machine. Compared with other types of vascular access, there is wide acceptance that arteriovenous fistulas (fistulas) provide best outcomes for patients because there is less likelihood of infection and clotting.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Miscarriage is pregnancy failure before 14 weeks, which is common in early pregnancy. Such a loss in early pregnancy can affect a woman’s physical and mental health. Doctors often suggest surgery such as dilation and curettage (D and C) or vacuum aspiration to complete the process. Surgery might cause problems such as trauma, heavy bleeding, or infection. Expectant management means waiting for the miscarriage to finish on its own, and may involve bed rest, examination by ultrasound, and antibiotics. This review looked at whether expectant management works as well as surgery for miscarriage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

One of the main aims of routine antenatal care is to identify babies who are not thriving in the womb. It is possible that medical interventions might improve outcomes for these babies, if they can be identified. Doppler ultrasound uses sound waves to detect the movement of blood in vessels. It is used in pregnancy to study blood circulation in the baby, uterus and placenta. Using it in high‐risk pregnancies, where there is concern about the baby's condition, shows benefits. However, its value as a screening tool in all pregnancies needs to be assessed as there is a possibility of unnecessary interventions and adverse effects. The review of trials of routine Doppler ultrasound of the baby’s vessels in pregnancy identified five studies involving more than 14,000 women and babies. The studies were not of high quality and were all undertaken in the 1990s. There were no improvements identified for either the baby or the mother, though more data would be needed to prove whether it is effective or not for improving outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

We reviewed the evidence about the effect of antioxidants and other medicines for Friedreich ataxia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Bibliographic details: Gao J X, Yao L H.  Value of contrast-enhanced ultrasonography in diagnosis of hepatic neoplasm: meta-analysis. Chinese Journal of Medical Imaging Technology 2009; 25(4): 646-649

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Bibliographic details: Zhang L, Cao F, Lei JQ.  Ultrasound and optical tomography image ultrasonography in differential diagnosis of benign and malignant breast tumors: meta-analysis. Chinese Journal of Medical Imaging Technology 2013; 29(8): 1292-1296 Available from: http://en.cnki.com.cn/Article_en/CJFDTotal-ZYXX201308023.htm

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

This review investigated whether showing (and explaining) to people their medical scan images motivates them to change their behaviour to reduce any health risks identified. This is important because getting people to change their health behaviours is generally very difficult. New techniques are needed and giving people visual evidence of how certain behaviours may be damaging their body could be an effective approach.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Hepatocellular carcinoma (HCC) is the most common primary malignant neoplasm of the liver, and accurate diagnosis and staging of HCC are important for guiding treatment and other clinical decisions. A number of imaging modalities are available for detection of HCC in surveillance and nonsurveillance settings, evaluation of focal liver lesions to identify HCC, and staging of HCC. The purpose of this review is to compare the effectiveness of imaging techniques for HCC on test performance, clinical decisionmaking, clinical outcomes, and harms.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: October 2014

Systematic Reviews in PubMed

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Systematic Review Methods in PubMed

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