***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review STUDY OBJECTIVE To assess the clinical use of ultrasonographic localization of the epidural space , and to evaluate the clinical efficacy of ultrasound diagnostics in obstetric anesthesia . DESIGN R and omized prospect i ve study . SETTING University Clinic of Obstetrics and Gynecology . PATIENTS 300 parturients , 85 of whom had conventional delivery and 65 who underwent cesarean section . INTERVENTIONS Patients underwent ultrasonography for the identification of the intervertebral structures . Puncture depth and angle were measured to improve the placement of the Tuohy needle . MEASUREMENTS In the ultrasound group , additional puncture data , optimized puncture point , expected puncture depth , and angle were used to optimize the puncture technique . To control for side effects , we compiled data on the number of puncture attempts and the number of necessary puncture levels , visual analog scale ( VAS ) scores , the rate of side effects , and the patient acceptance of the technique . MAIN RESULTS The two groups were similar regarding demographic data . Using ultrasound for structure detection , the rate of puncture attempts were significantly ( p < 0.013 ) reduced from 2.18 + /- 1.07 to 1.35 + /- 0.61 . The mean rate of necessary puncture levels was 1.30 + /- 0.55 and with ultrasound detection 1.136 + /- 0.36 ( p < 0.029 ) . Complete analgesia was achieved in 147 patients with ultrasound detection versus 138 patients in the Control group ( p < 0,03 ) . The maximum VAS pain score in the control group was 1.3 + /- 2.1 versus 0.8 + /- 1.5 in the Ultrasound group ( p < 0.006 ) . The rate of side effects were reduced significantly : 99 patients in the Control group had no side effects compared with 120 patients from the Ultrasound group who were free of side effects . Patient acceptance of the technique in the Ultrasound group was significantly higher than in the Control group . CONCLUSION The clinical use of ultrasound for epidural catheter placement may improve regional anesthesia . The use of ultrasound result ed in superior quality in all measured endpoints BACKGROUND We report a prospect i ve , r and omized study to evaluate ultrasound guidance for epidural catheter placement in children 0 - 6 yr of age . METHODS Epidural catheters were placed at lumbar or thoracic cord levels in 64 children undergoing major surgery , using either ultrasonography or loss-of-resistance ( LOR ) for guidance . Using a 5 - 10 MHz linear ultrasound probe , the neuraxial structures were identified , the skin-epidural depth and epidural space was measured , the advancing epidural catheter visualized , and the spread of local anaesthetic verifying catheter position was confirmed . Epidural placement procedures were analysed for bone contacts and speed of execution . Children under 6 months were analysed separately . RESULTS Epidural placement involved bone contacts in 17 % of children in the ultrasound group and 71 % of children in the LOR group ( P<0.0001 ) . Epidurals were executed more swiftly in the ultrasound group [ 162 ( 75 ) s vs 234 ( 138 ) s ; P<0.01 ] . Children under 6 months revealed a 0.9 correlation between skin-epidural depth and body weight . CONCLUSIONS Ultrasonography is a useful aid to verify epidural placement of local anaesthetic agents and epidural catheters in children . Advantages include a reduction in bone contacts , faster epidural placement , direct visualization of neuraxial structures and the spread of local anaesthetic inside the epidural space .  Ultrasound guidance requires additional training and good manual skills , and should only be used once experience in ultrasound-guided techniques of regional anaesthesia has been acquired BACKGROUND Epidural analgesia is widely used for pain relief during labor . The purpose of this study was to determine if ultrasound measurement of the depth from skin to epidural space before the epidural technique decreases the failure rate of labor analgesia . A secondary objective was to correlate ultrasound depth to the epidural space with actual depth of the needle at placement . METHODS In this prospect i ve , r and omized , non-blinded study , 370 parturients requesting labor epidural analgesia were r and omized to receive their epidural technique by first year anesthesia residents  with or without prior ultrasound determination of epidural space depth . Outcome variables included the incidence of epidural catheter replacement for failed analgesia and the number of epidural attempts and accidental dural punctures . RESULTS The ultrasound group had fewer epidural catheter replacements ( P<0.02 ) , and epidural placement attempts ( P<0.01 ) compared to the control group . Pearson 's correlation coefficients comparing the actual versus ultrasound estimated depth to the epidural space in the longitudinal median and transverse planes were 0.914 and 0.909 , respectively . Pearson 's correlation coefficient comparing the ultrasound estimated depths to the epidural space in the transverse and longitudinal median planes was 0.940 . No significant differences were noted with respect to staff interventions , top-ups , accidental dural punctures , and delivery outcome . CONCLUSIONS Ultrasound measurement of the epidural space depth before epidural technique placement decreases the rate of epidural catheter replacements for failed labor analgesia , and reduces the number of epidural attempts when performed by first year residents and compared to attempts without ultrasound guidance Background and objective : The quality of combined spinal-epidural anaesthesia mainly depends on accurate identification of the epidural space . The real-time ultrasound control of the procedure for puncture was therefore evaluated . Methods : Thirty parturients scheduled for Caesarean section were r and omized to three equal groups . Ten control patients received conventional combined spinal-epidural anaesthesia . Ten of the remaining patients received ultrasonic scans by an offline scan technique , and 10 received online imaging of the lumbar region during epidural puncture . The epidural space was identified and needle advancement was surveyed through the interspinal and flaval ligaments . The number of attempts to advance the needle to achieve a successful puncture was measured and compared , as well as the number of vertebral interspaces punctured before successful entry into the epidural space . Results : There was no difference between patient characteristics in the three groups . The visualization of the epidural structures and of the needle manipulations was very effective . In the ultrasound group , the reduction in the number of attempts at puncture was significant ( P < 0.036 ) . The number of interspaces necessary for puncture was reduced ( P < 0.036 ) in the ultrasound online group compared with controls . The number of spinal needle manipulations was significantly reduced ( P < 0.036 ) . Conclusions : Real-time ultrasonic scanning of the lumbar spine is an easy procedure . It provides an accurate reading of the location of the needle tip and facilitates the performance of combined spinal-epidural anaesthesia Background and objective Lumbar epidural anaesthesia usually affects both legs . The aim was to compare the success rates of ultrasound-aided vs. classical midline epidural catheter insertion for ipsilateral-dominant blocks and analgesia in patients undergoing total hip arthroplasty . Methods The protocol was design ed as a prospect i ve r and omised single-blind study . In the ultrasound group ( n = 12 ) , ultrasound examination was performed to determine the puncture point and direction for ipsilateral-dominant block . In the midline group ( n = 12 ) , epidural puncture was performed by the usual midline approach . Rates of successful ipsilateral-dominant block using 6 ml of lidocaine 1.5 % wt vol−1 ( primary outcome ) and effects of patient-controlled epidural analgesia using ropivacaine 0.2 % wt vol−1 ( secondary outcomes ) were evaluated . Results The rates of successful ipsilateral-dominant block were 83 % in the ultrasound group and 17 % in the midline group ( P = 0.004 ) . Sensory and motor functions on the non-operated side in the ultrasound group were significantly better maintained than those on the operated side and compared with those on the non-operated side in the midline group ( P < 0.05 ) . Pain scores at mobilisation , incidence of post-operative nausea and vomiting and frequency of use of supplemental analgesics were significantly lower in the ultrasound group than in the midline group ( P < 0.05 ) . Conclusion The use of ultrasound significantly improves the success rate of ipsilateral epidural block compared with the st and ard midline approach Background : The efficacy of epidural anaesthesia depends on the accurate identification of the epidural space ( ES ) . Abnormal anatomical conditions may make the procedure difficult or impossible . The aim of this study was to investigate whether pre‐puncture ultrasound examination of the spinal anatomy might be beneficial in expected cases of difficult epidural anaesthesia OBJECTIVE Evidence showing the systematic utility of ultrasound imaging during  lumbar puncture ( LP ) in the emergency department is lacking . Our hypothesis was that ultrasound-assisted LP would increase the success rate and ease of performing LP  with a greater benefit in obese patients . METHODS This was an Institutional Review Board-approved , r and omized , prospect i ve , double-blind study conducted at the emergency department of a teaching institution . Patients undergoing LP from January to December 2004 were eligible for enrollment . Patients were r and omized to undergo LP using palpation l and marks ( PLs ) or ultrasound l and marks ( ULs ) . Data collected included age , body mass index , number of attempts , ease of performance and patient comfort on a 10-cm Visual Analog Scale , procedure time , success , and traumatic LP . Statistical analysis of data included relative risk ( RR ) , the Mann-Whitney U test , and the Student t test . RESULTS A total of 46 patients were enrolled , 22 r and omized to PLs and 24 to ULs . There were no differences between the groups in mean age or body mass index . Six of 22 attempts failed with PLs versus 1 of 24 with ULs ( RR , 1.32 ; 95 % confidence interval , 1.01 - 1.72 ) . In 12 obese patients , 4 of 7 PL attempts failed versus 0 of 5 UL attempts ( RR , 2.33 ; 95 % confidence interval , 0.99 - 5.49 ) . The ease of the procedure was better with ULs versus PLs . There were no statistical differences in the number of attempts , traumatic LPs , patient comfort , or procedure length . CONCLUSIONS The use of ultrasound for LP significantly reduced the number of failures in all patients and improved the ease of the procedure in obese patients Combined spinal and epidural analgesia ( CSE ) is widely used to provide analgesia for cesarean delivery . The success and quality of analgesia depend on correct cannulation of the epidural space ( ES ) . Epidural puncture is traditionally guided using surface l and marks and the loss-of-resistance ( LOR ) technique . However , difficulty in identifying surface l and marks ( e.g. , the obese patient ) and deviation of the needle trajectory from midline may lead to failed or asymmetric epidural block . To facilitate ES cannulation , additional information regarding puncture depth and axis from the skin ’s surface would be desirable . Diagnostic imaging including plain radiography , computed tomography , and magnetic resonance imaging ( MRI ) can provide accurate anatomic information regarding the location of the epidural space , but their use is impractical in most clinical setting s where epidural analgesia is used . In contrast , the safety and feasibility of bedside ultrasonography during pregnancy are well established . In the present study , we used ultrasonography to measure the ES depth ( i.e. , the distance from the skin to the ligamentum flavum ) and to gain additional information on neighboring anatomical structures before performing the epidural block . We assessed the usefulness of ultrasonography in facilitating successful localization of the epidural space compared with the LOR technique alone in a group of parturients undergoing CSE for elective cesarean delivery . 
    Output:
    
Ultrasound imaging can reduce the risk of failed or traumatic lumbar punctures and epidural catheterisations , as well as the number of needle insertions and redirections .
Ultrasound may be a useful adjunct for these procedures