How accurate are contrast-enhanced ultrasound scans for detecting hepatocellular carcinoma? Key messages In adults with chronic liver disease, contrast-enhanced ultrasound (CEUS) can miss diagnosing hepatocellular carcinoma in around 22.2% of people who would not then receive timely or appropriate treatment, and would fail to diagnose hepatocellular carcinoma in 6.2% of people who could receive unnecessary further testing or treatment. In the subset of people who are able have the hepatocellular carcinoma removed by surgery, CEUS probably misses hepatocellular carcinoma in 22.5% of people...

Conservative interventions for urinary incontinence in women: an overview of Cochrane Reviews What is urinary incontinence? Bladder problems are common in women. Having to go to the toilet frequently, urgently and sometimes not making it in time is called urgency urinary incontinence. Urgency urinary incontinence occurs when, for some reason, the signals telling women to empty their bladder are much stronger and occur more often than necessary. Leaking when sneezing or exercising is called stress urinary incontinence, and can happen if the muscles controlling the outlet from the bladder are...

Mothers' positions in labour when baby is lying 'back-to-back' What is the issue? Malposition is when the back of the baby's head lies towards the mother's back. As a result, labour and birth can be long and difficult, sometimes resulting in an operative birth (where the baby is delivered by caesarean section or with special tools to help the baby through the birth canal) and more perineal trauma (damage to the pelvic floor). The baby may be more likely to go to a neonatal care unit. Also, women may experience stress or disappointment with the birth experience. Why is this...

Reduction in the number of antipsychotics for people with schizophrenia Key messages – Reducing the number of antipsychotics may be associated with more participants leaving the study early, especially due to inefficacy. - The low number of studies and participants do not allow us to make strong conclusions. Introduction Schizophrenia is a severe mental disorder. People with the illness struggle to differentiate between their own thoughts, beliefs and ideas versus reality. For example, they may be hearing voices in their head but it feels like someone is really talking to them. It is mainly...

D-mannose (sugar tablets) for preventing or treating urinary tract infections in adults and children What is the issue? Urinary tract infections (UTIs) are very common around the world. At least 50% of females will have a UTI once in their lifetime. Approximately 15% to 25% of adults and children suffer from repeated and long-term UTIs. In many people, standard antibiotics do not work. D-mannose is a sugar which is part of a normal diet and is believed to create a non-stick surface on the bladder wall, as well as around the bacteria. It is thought that the bacteria is then expelled when...

Interventions for preventing and reducing the use of physical restraints of older people in hospital What was studied in this review? Physical restraints are devices which reduce a person's freedom to move. These can be bedrails, belts in chairs or beds, and fixed tables, which prevent people from getting out of bed or a chair, or mitts which prevent someone using their hands freely. In some countries, physical restraints are used quite commonly for older people in general hospital wards. A main reason for this is to try to prevent falls and fall-related injuries, or to prevent people from...

Barriers and facilitators of and strategies for successful community engagement in infectious disease clinical trials in low- and middle-income countries This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: 1. To identify and synthesise barriers and facilitators of successful community engagement in infectious disease clinical trials (e.g. HIV, tuberculosis, and malaria) in low- and middle-income countries; and 2. To identify and synthesise strategies for engaging community stakeholders in infectious disease clinical trials in low- and middle-income...

Can a dementia medicine (memantine) help people with autism spectrum disorder? Background Autism spectrum disorder (autism) is a condition that begins in childhood. Core symptoms include persistent difficulties with social communication (e.g. difficulties with back-and-forth conversations, communication without words, and in developing and maintaining relationships), and repetitive and restricted interests and behaviours (e.g. repetitive mannerisms, restricted interests and behaviours, resistance to change and sensory sensitivities). Around 1% to 2% of children have autism. Autistic people...

Acupuncture for insomnia in people with cancer This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of acupuncture therapy for insomnia in people with cancer, during and after active anti-cancer treatment. We will evaluate the effects at different periods of treatment in relation to cancer treatment (before, during, or after treatment), and analyse the effects of acupuncture on quality of life. This is a protocol....

Ultrasound guidance versus anatomical landmarks for neuraxial anaesthesia in adults This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the clinical efficacy and safety of ultrasound guidance compared with anatomical landmarks for neuraxial anaesthesia in adults. This is a protocol....

What is the effectiveness and safety of luteal support in infertile women trying to conceive by intrauterine insemination (IUI) or by sexual intercourse? Background Luteal phase is part of the menstrual cycle. It is the time between the release of an egg (ovulation) and before the start of menstruation, and when the body produces progesterone (a hormone released by the ovaries) and prepares for a possible pregnancy. Ovarian stimulation (use of fertility medicines) might affect progesterone production during the luteal phase. Low levels of progesterone in the luteal phase are associated with...

School feeding programs for improving the physical and psychological health of school children experiencing socioeconomic disadvantage This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of school feeding programs for improving the physical and psychological health of children experiencing socioeconomic disadvantage across the world. To compare the effectiveness of school feeding programs for children experiencing socioeconomic disadvantage and those experiencing socioeconomic advantage. This includes subgroups by income and...

Liver and spleen stiffness as assessed by vibration controlled transient elastography for diagnosing clinically significant portal hypertension in comparison with other elastography-based techniques in adults with chronic liver disease This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To assess the diagnostic accuracy of liver stiffness and spleen stiffness, as well as their combination, as measured by vibration-controlled transient elastography (VCTE) in the detection of clinically significant portal hypertension (CSPH) in adults with chronic liver...

Mistletoe extracts for cancer treatment This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of mistletoe extracts (Viscum album, European mistletoe) as antitumour treatment and for supportive/palliative care in adults with cancer. We will assess whether mistletoe extracts administered alone or in combination with tumour-specific therapies prolong progression free-intervals (PFI) and/or overall survival (OS); enhance tumour response; alleviate treatment-related adverse effects from conventional cancer treatment e.g. chemo‐ or...

Does use of mouth rinse before a dental procedure reduce the risk of infection transmission from patient to health professional? Why is this question important? Many dental procedures generate droplets that settle on a surface quickly. If high-speed instruments, such as a drill, are used, aerosols are generated, which consist of tiny particles that remain suspended in the air and that can be inhaled or that settle farther away on surfaces. These aerosols contain a variety of micro-organisms and may transmit infections either through direct contact or indirectly through the contaminated...

Running shoes for preventing lower-limb running injuries in adults Title Do different types of running shoes change the risk of developing a lower-limb injury? Key messages Neutral/cushioned shoes may make little or no difference to the number of runners sustaining injuries or footwear satisfaction compared with minimalist shoes. It is uncertain if motion control shoes reduce the number of runners sustaining injuries compared with neutral/ cushioned shoes. Soft midsole shoes may make little or no difference to the number of runners sustaining injuries compared with hard midsole shoes. It is...

Interventions to improve psychosexual function in women treated for gynaecological cancers This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effectiveness and safety of interventions to improve psychosexual function in women treated for gynaecological cancers. This is a protocol....

The impact of cumulative medications with anticholinergic effects on future adverse clinical outcomes in people with dementia Key messages Anticholinergic medicines may increase the risk of death in older adults who have dementia. However, the evidence is low certainty, and we cannot say for certain if the anticholinergic medicines cause death, or if they are simply more likely to be used by people who are already at an increased risk of dying due to ongoing health problems. We cannot draw firm conclusions for the risk that anticholinergic medicines pose to the development of other...

What are the benefits of supervised programmes of exercise and education (known as pulmonary rehabilitation) compared with usual care for adults with asthma? Key messages - We found that people with asthma who take part in supervised programmes of exercise and education (known as pulmonary rehabilitation) are likely to get fitter (can walk further) and have better wellbeing immediately after completing these programmes compared to those who receive usual care. However, we are not certain if these benefits persist up to one year later. - Due to a lack of evidence, the effects of pulmonary...

Cognitive behavioural therapy for insomnia in people with cancer This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of cognitive behavioural therapy (CBT) for insomnia in people with cancer. We will evaluate the effects at different periods of the cancer treatment (before, during, or after treatment), and analyse the effects of CBT on quality of life. This is a protocol....