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Biomedical subjects

E Ernst

Publications and source records attributed to E Ernst.

At least 253 records · Page 14Linked to original sources
PubMed2000

Feverfew for preventing migraine.

BACKGROUND: Feverfew (Tanacetum parthenium L.) is a popular herbal remedy for migraine. OBJECTIVES: To systematically review the evidence for or against the efficacy of feverfew versus placebo for the prevention of migraine. SEARCH STRATEGY: Electronic literature searches were performed using the databases CISCOM (Research Council for Complementary Medicine, London, UK), MEDLINE, EMBASE, Biosis and the Cochrane Library (each from its inception to April 1998). Manufacturers were contacted and the bibliographies of identified articles checked for further trials. SELECTION CRITERIA: Randomised, placebo-controlled, double-blind trials assessing the efficacy of feverfew for preventing migraine were included. No restrictions regarding the language of publication were imposed. DATA COLLECTION AND ANALYSIS: Data on patients, interventions, methods, outcomes and results were extracted in a pre-defined, standardised manner. Methodological quality was evaluated using the scoring system developed by Jadad and colleagues. Both data extraction and the assessment of methodological quality were performed independently by two reviewers. MAIN RESULTS: Four trials met the inclusion criteria. The majority of these trials suggested beneficial effects of feverfew compared with placebo. However, the trial with the highest methodological quality, which was also among the largest, found no significant difference between feverfew and placebo. REVIEWER'S CONCLUSIONS: The efficacy of feverfew for the prevention of migraine has not been established beyond reasonable doubt.

Complementary Therapies↗
PubMed2000

Color-coded duplex sonography of the cervical lymph nodes: improved differential diagnostic assessment after administration of the signal enhancer SH U 508A (Levovist).

The vascularity of cervical lymph nodes can be documented by means of color-coded duplex sonography and malignant and benign lymph nodes distinguished on the basis of typical patterns of vascularity. However, not all intranodal vessels can be visualized by color-coded duplex sonography, and minute vessels are detectable only after the administration of a signal enhancer. This also makes it possible to assess the morphology of cervical lymph nodes that are inaccessible on plain sonography. In the present study we examined acute and chronic inflammatory and metastatic lymph nodes as well as malignant lymphomas to determine the extent to which a specific pattern of vascularity can be detected with color-coded duplex sonography after the injection of Levovist as a signal enhancer. In addition, digital image processing was used to quantify the vascularity detected in relation to the cross-sectional area of the lymph nodes as seen at sonography and to determine whether there are any differences in lymph node types as regards an increase in the detection of vascularity. After injection of the marker a typical pattern of vascularity could be assigned to all lymph nodes examined and differences shown in quantifying vascularity: This increase was greatest in the acutely inflamed lymph nodes (36.0 +/- 5.0%) and smallest in lymph nodes with chronic inflammation (2.3 +/- 1.3%). These findings show that cervical lymph nodes of varying origin differ by virtue of their pattern of vascularity, with increased vascularity detectable after administration of a signal enhancer.

Carcinoma, Squamous Cell↗
PubMed2000

Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials.

PURPOSE: The optimal treatment of intermittent claudication has not yet been identified. Ginkgo biloba extract has been reported to have beneficial effects. We performed a meta-analysis of the efficacy of Ginkgo biloba extract for intermittent claudication based on the results of randomized, placebo-controlled, double-blind trials. METHODS: Literature searches of MEDLINE, EMBASE, BIOSIS, AMED, CISCOM, and the Cochrane Library were performed to identify studies on the topic. Manufacturers of commercial Ginkgo biloba products and authors of original publications and reviews were contacted to provide additional information. No language restrictions were imposed. RESULTS: Eight randomized, placebo-controlled, double-blind trials were included. Meta-analysis found a significant difference in the increase in pain-free walking distance in favor of Ginkgo biloba (weighted mean difference: 34 meters, 95% confidence interval [CI]: 26 to 43 meters). In studies using similar methodological features (ergometer speed: 3 km/h, inclination: 12%) this difference was 33 meters in favor of Ginkgo biloba (95% CI: 22 to 43 meters). Adverse effects were rare, mild, and transient. CONCLUSIONS: These results suggest that Ginkgo biloba extract is superior to placebo in the symptomatic treatment of intermittent claudication. However, the size of the overall treatment effect is modest and of uncertain clinical relevance.

Double-Blind Method↗
PubMed2000

Phyto-anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials.

Herbal treatments are often used to treat rheumatic symptoms. This systematic review is aimed at determining the clinical efficacy of this approach. Computer literature searches are carried out to locate all placebo-controlled, double-blind, randomized trials in this area. Nineteen studies meet the inclusion criteria. They are heterogeneous in terms of remedies tested, patients treated, and trial methodology applied. Most of the studies suggest that herbal remedies can have symptomatic effects beyond placebo. It is concluded that phyto-anti-inflammatories have considerable, albeit under-researched, potential in the symptomatic treatment of rheumatic disorders.

Anti-Inflammatory Agents↗
PubMed2000

Location bias in controlled clinical trials of complementary/alternative therapies.

UNLABELLED: To systematically investigate location bias of controlled clinical trials in complementary/alternative medicine (CAM). METHODS: Literature searches were performed to identify systematic reviews and meta-analyses, which were used to retrieve controlled clinical trials. Trials were categorised by whether they appeared in CAM-journals or mainstream medical (MM)-journals, and by their direction of outcome, methodological quality, and sample size. RESULTS: 351 trials were analysed. A predominance of positive trials was seen in non-impact factor CAM- and MM-journals, (58) / (78) (74%) and (76) / (102) (75%) respectively, and also in low impact factor CAM- and MM-journals. In high impact factor MM-journals there were equal numbers of positive and negative trials, a distribution significantly (P < 0.05) different from all other journal categories. Quality scores were significantly lower for positive than negative trials in non-impact factor CAM-journals (P < 0.02). A similar trend was seen in low-impact factor CAM journals, but not to a level of significance (P = 0.06). There were no significant differences between quality scores of positive and negative trials published in MM-journals, except for high impact factor journals, in which positive trials had significantly lower scores than negative trials (P = 0.048). There was no difference between positive and negative trials in any category in terms of sample size. CONCLUSION: More positive than negative trials of complementary therapies are published, except in high-impact factor MM-journals. In non-impact factor CAM-journals positive studies were of poorer methodological quality than the corresponding negative studies. This was not the case in MM-journals which published on a wider range of therapies, except in those with high impact factors. Thus location of trials in terms of journal type and impact factor should be taken into account when the literature on complementary therapies is being examined.

Acupuncture Therapy↗
PubMed2000

The role of complementary and alternative medicine in cancer.

Many cancer patients use complementary and alternative medicines. Oncologists therefore need to learn more about this subject. Dietary treatments, herbal medicinal products, and various food supplements are currently being promoted as 'cancer cures', but none of these treatments are backed up by convincing clinical evidence. For some interventions, however, the evidence is sufficiently encouraging to warrant further research. Several forms of complementary and alternative medicine play a part in supportive care for cancer patients. The evidence for this approach is still preliminary but, generally speaking, promising. The challenge for the future is to obtain reliable evidence and to identify those approaches that do more good than harm.

Complementary Therapies↗
PubMed2000

The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review.

OBJECTIVE: Feverfew (Tanacetum parthenium L.) is a popular herbal remedy often advocated for the prevention of migraine. The aims of this systematic review are to update the evidence from rigorous clinical trials for or against the efficacy of feverfew for migraine prevention and to provide a safety profile of this herbal remedy. DESIGN: Literature searches were performed using the following databases: Medline, Embase, Biosis, CISCOM and the Cochrane Library (all from their inception to December 1999). Only randomized, placebo-controlled, double-blind trials of feverfew mono-preparations for the prevention of migraine in human subjects were included. All articles were read by two independent reviewers. Data were extracted in a pre-defined, standardized fashion. The methodological quality of the trials was evaluated by the Jadad score. For the assessment of safety issues, major reference texts were also consulted. RESULTS: Six trials met the inclusion/exclusion criteria. The majority favour feverfew over placebo. Yet important caveats exist. The data also suggest that feverfew is associated with only mild and transient adverse effects and few other safety concerns. CONCLUSIONS: Feverfew is likely to be effective in the prevention of migraine. There are no major safety problems.

Humans↗
PubMed2000

The usage of complementary therapies by dermatological patients: a systematic review.

Complementary medicine (CM) is more popular than ever before. Dermatology has not remained unaffected by this trend. The aim of this systematic review was to summarize all surveys of dermatological patients regarding the usage of CM. Three independent literature searches were carried out. Data were extracted in a predefined, standardized way and evaluated descriptively. Seven surveys met the inclusion/exclusion criteria. Collectively they show a high but variable prevalence of CM. Lifetime prevalence ranged from 35 to 69%. The most frequently used treatment modalities comprise homoeopathy, herbalism and food supplements. With this high level of prevalence, research into the potential risks and benefits of CM is urgently needed. Dermatologists should consider discussing CM openly with their patients.

Complementary Therapies↗
PubMed2000

Adverse effects of herbal drugs in dermatology.

Herbal treatments are becoming increasingly popular, and are often used for dermatological conditions. Thus dermatologists should know about their potential to cause adverse events. This review is aimed at addressing this area in a semisystematic fashion. Some agents, particularly Chinese herbal creams, have been shown repeatedly to be adulterated with corticosteroids. Virtually all herbal remedies can cause allergic reactions and several can be responsible for photosensitization. Some herbal medicines, in particular Ayurvedic remedies, contain arsenic or mercury that can produce typical skin lesions. Other popular remedies that can cause dermatological side-effects include St John's Wort, kava, aloe vera, eucalyptus, camphor, henna and yohimbine. Finally, there are some herbal treatments used specifically for dermatological conditions, e.g. Chinese oral herbal remedies for atopic eczema, which have the potential to cause systemic adverse effects. It is concluded that adverse effects of herbal medicines are an important albeit neglected subject in dermatology, which deserves further systematic investigation.

Complementary Therapies↗
PubMed2000

Association between plasma viscosity and all-cause mortality: results from the MONICA-Augsburg Cohort Study 1984-92.

Several studies have reported a strong association between various markers of the acute-phase response and death from cardiovascular diseases and all-cause mortality. Inflammation at a low level of intensity may be a common phenomenon associated with the majority of causes of death owing to chronic diseases. We sought to investigate the association of plasma viscosity with all-cause mortality in a cohort of apparently healthy men. The study population consisted of 964 men aged 45-64 years at entry, randomly selected from the general population and taking part in the first MONICA-Augsburg survey 1984-85. The main outcome measure was all-cause mortality. During 8 years of follow-up, there were 81 deaths (37 cardiovascular deaths, 23 deaths from cancer and 21 deaths from other causes). There was a strong positive and statistically significant age-adjusted relationship between plasma viscosity and all-cause mortality. The relative risk of death for a one standard deviation increase in plasma viscosity (0.070 mPa/s) was 1.45 [95% confidence interval (CI) 1.19-1.76]. After further adjusting for smoking, total cholesterol, body mass index, blood pressure and education, a relative risk of 1.41 (95% CI 1.14-1.74) resulted. Other risk variables had only negligible confounding effects. The relative risk of the median of the top quintile of the plasma viscosity distribution compared with the median of the bottom quintile, computed from the adjusted model, was 2.68 (95% CI 1.63-4.42). These findings suggest that plasma viscosity may have considerable potential to predict death from all causes in middle-aged men.

Acute-Phase Reaction↗
PubMed2000

Complementary and alternative medicine in rheumatology.

Complementary and alternative medicine (CAM) has become an important subject for rheumatologists. This article is an attempt to provide an introduction to this subject. It will provide definitions of, and define the prevalence of, CAM. The emphasis of the article is on evaluating the efficacy of CAM treatment modalities. This is achieved by referring to systematic reviews of clinical trials of acupuncture for low back pain, osteo-arthritis, fibromyalgia, inflammatory rheumatoid disease and neck pain. Further areas addressed in this way are herbal remedies, fish oil and glucosamine. Moreover, massage therapy and spinal manipulation for back pain are discussed. The final sections of this review deal with the safety and cost of CAM. It is concluded that, in view of the popularity of CAM with rheumatological patients, rigorous research into CAM is the best way forward.

Complementary Therapies↗
PubMed2000

Autogenic training for stress and anxiety: a systematic review.

OBJECTIVE: The aim of this systematic review was to evaluate all controlled trials of autogenic training (AT) as a means of reducing stress and anxiety levels in human subjects. METHOD: A search for all published and unpublished controlled trials was carried out in the four major databases, specifically CISCOM, Medline, PsychLit and CINAHL. RESULTS: Eight such trials were located, all of which are included here. The majority of trials were methodologically flawed. A range of outcome measures were used, with Spielberger's State-Trait Anxiety Inventory being the most popular. Deviations from the accepted technique of AT were conspicuous and trials using the classical AT were in the minority. Seven trials reported positive effects of AT in reducing stress. One study showed no such benefit. Since one trial had used AT in combination with another technique, visual imagery, no conclusion can be drawn about the effect of AT in this case. CONCLUSION: No firm conclusions could be drawn from this systematic review. AT, properly applied, remains to be tested in controlled trials that are appropriately planned and executed.

Anxiety↗
PubMed2000

Economic analysis of complementary medicine: a systematic review.

OBJECTIVE: To review systematically all reports of economic analysis of complementary and alternative medicine. METHOD: Searches were performed in Medline, Embase and AMED for reports of cost description, cost comparison, cost effectiveness, or cost benefit studies. Prospective studies that investigated comparative groups were considered to be of higher quality. RESULTS: A total of 34 reports was included. Retrospective studies in which a range of therapies are provided in primary care suggest that these may reduce referral and treatment costs, but prospective studies suggest that complementary medicine is an additional expense and does not substitute for orthodox care. For individual therapies, one thorough but retrospective study suggests that carefully targeted acupuncture may reduce referral costs for musculoskeletal problems. One large pragmatic study of spinal manipulative therapy suggests that this treatment may reduce the societal costs of back pain, but four controlled trials found that manipulative therapy does not reduce the costs incurred by the back pain patients themselves or by their health insurance provider. CONCLUSION: Spinal manipulative therapy for back pain may offer cost savings to society, but it does not save money for the purchaser. There is a paucity of rigorous studies that could provide conclusive evidence of differences in costs and outcomes between other complementary therapies and orthodox medicine. The evidence from methodologically flawed studies is contradicted by more rigorous studies, and there is a need for high quality investigations of the costs and benefits of complementary medicine.

Complementary Therapies↗
PubMed2000

Complementary and alternative therapies for treating multiple sclerosis symptoms: a systematic review.

Multiple sclerosis (MS) is a chronic disease of the central nervous system without a known cure. Thus the role of complementary and alternative therapies (CATs) for the management of symptoms lies in palliative care and this is borne out by the popularity of these treatments amongst MS sufferers. This review is aimed at determining whether this use is supported by evidence of effectiveness from rigorous clinical trials. Database literature searches were performed and papers were extracted in a pre-defined manner. Twelve randomized controlled trials were located that investigated a CAT for MS: nutritional therapy (4), massage (1), Feldenkrais bodywork (1), reflexology (1), magnetic field therapy (2), neural therapy (1) and psychological counselling (2). The evidence is not compelling for any of these therapies, with many trials suffering from significant methodological flaws. There is evidence to suggest some benefit of nutritional therapy for the physical symptoms of MS. Magnetic field therapy and neural therapy appear to have a short-term beneficial effect on the physical symptoms of MS. Massage/bodywork and psychological counselling seem to improve depression, anxiety and self-esteem. The effectiveness for other CATs is unproven at this time. In all the CATs examined further investigations are needed in the form of rigorous large-scale trials.

Complementary Therapies↗
PubMed2000

Can singing exercises reduce snoring? A pilot study.

BACKGROUND: Snoring is not merely a common nuisance but has been identified as a risk factor for poor health. Last resort treatments for palate-based snoring are surgical - reducing the amount of soft palate and/or stiffening it by causing scarring. They carry a burden of risk and expense and have a high recurrence rate. OBJECTIVE: This pilot study was a first step in determining whether singing exercises could be used as a non-invasive treatment to increase muscle tone in the tissues of the throat and thereby reduce snoring. METHOD: The duration of snoring of 20 chronic snorers was recorded by voice-activated tape recorder for 7 nights both before and after treatment. The therapeutic intervention consisted of instruction in singing technique and singing exercises which subjects were directed to practice for 20 minutes a day for 3 months. Compliance was encouraged by a further visit and regular telephone follow-ups. RESULTS: Snoring was on average reduced, especially in subjects who performed the exercises accurately and consistently and who were not overweight. Those who did best, in addition, had no nasal problems and began snoring only in middle age. CONCLUSION: A further randomized controlled study focusing on this group would appear justified and is being planned.

Adult↗