[Nightmare impact factor].
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Bibliometrics↗
Biomedical subjects
K L Resch
Publications and source records attributed to K L Resch.
[A hospital suited version of the German SF-36 and its psychometric comparison with the original questionnaire].
OBJECTIVES: The application of the Short-Form 36 Health Survey (SF-36) in hospitals is sometimes problematic, because some formulations like "at work" or "at home" in some items are not adequate in a hospital context. To account for this problem, we deleted 23 words like "at work" and "at home" from the SF-36 and generated thus a slightly modified version, the SF-36 m. The present paper deals primarily with two questions: is the SF-36 m well applicable in hospitals and is it still equivalent with the original version? METHODS: The SF-36 m was applied in more than 300 patients in two different hospitals. In one hospital a randomised design was used to assess the equivalence of SF-36 and SF-36 m before treatment. RESULTS: The reported high percentages of missing values in four critical scales were no more observed, when the SF-36 m was applied at the end of hospital stays. Only minor differences between SF-36 and SF-36 m with effect sizes < 0.20 were observed, although the scale "physical role function" and especially item 4d showed unexpectedly significantly higher values in the SF-36 m (p < 0.10). Additionally, higher and significant differences were observed between the applications of the questionnaires at home and in the hospital. CONCLUSIONS: Opposed to the original SF-36 the SF-36 m is well applicable at the end of hospital stays. SF-36 and SF-36 m show only minor differences in the comparison of their equivalence. The application of SF-36 and SF-36 m in hospitals seems to yield more favourable scores of health related quality of life than the application at home.
Chronic Disease↗
Analgesic effectiveness of subcutaneous carbon-dioxide insufflations as an adjunct treatment in patients with non-specific neck or low back pain.
OBJECTIVES: To evaluate the analgesic effectiveness of subcutaneous carbon-dioxide insufflations in addition to standard physical treatment in patients with non-specific neck or low back pain. DESIGN: A pragmatic, randomized controlled trial. SETTING: Rehabilitation hospital inpatients. INTERVENTIONS: Patients received either subcutaneous carbon-dioxide insufflations (10 treatments) and standard physical treatment or standard physical treatment only. OUTCOME MEASURES: Affective pain perception (42-point scale), sensory pain perception (30-point scale), pain intensity (100 mm visual analogue scale). RESULTS: Between-groups differences were -2.2 [95% CI -5.2; +0.9] (affective pain perception), -1.2 [-3, 0; + 0.7] (sensory pain perception), and -6.5 [-14; +1.0] (pain intensity) respectively in favour of subcutaneous carbon-dioxide insufflations. CONCLUSIONS: Subcutaneous carbon-dioxide insufflations do not seem to be a worthwhile adjunct in the given setting of inpatient rehabilitation. Trials in a monotherapeutic setting, which aim more at the efficacy of subcutaneous carbon-dioxide insufflations, might help to solve this issue.
Aged↗
Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review.
Clinical experience suggests that fasting followed by vegetarian diet may help patients with rheumatoid arthritis (RA). We reviewed the available scientific evidence, because patients frequently ask for dietary advice, and exclusive pharmacological treatment of RA is often not satisfying. Fasting studies in RA were searched in MEDLINE and by checking references in relevant reports. The results of the controlled studies which reported follow-up data for at least three months after fasting were quantitatively pooled. Thirty-one reports of fasting studies in patients with RA were found. Only four controlled studies investigated the effects of fasting and subsequent diets for at least three months. The pooling of these studies showed a statistically and clinically significant beneficial long-term effect. Thus, available evidence suggests that fasting followed by vegetarian diets might be useful in the treatment of RA. More randomised long-term studies are needed to confirm this view by methodologically convincing data.
Arthritis, Rheumatoid↗
Improvement of thigh muscles by neuromuscular electrical stimulation in patients with refractory heart failure: a single-blind, randomized, controlled trial.
OBJECTIVE: To determine the impact of an 8-wk neuromuscular stimulation program of thigh muscles on strength and cross-sectional area in patients with refractory heart failure listed for transplantation. DESIGN: Forty-two patients with a stable disease course were assigned randomly to a stimulation group (SG) or a control group (CG). The stimulation protocol consisted of biphasic symmetric impulses with a frequency of 50 Hz and an on/off regime of 2/6 sec. RESULTS: Primary outcome measures were isometric and isokinetic thigh muscle strength and muscle cross-sectional area. Our results showed an increase of muscle strength by mean 22.7 for knee extensor and by 35.4 for knee flexor muscles. The CG remained unchanged or decreased by -8.4 in extensor strength. Cross-sectional area increased in the SG by 15.5 and in the CG by 1.7. CONCLUSIONS: Activities of daily living as well as quality of life increased in the SG but not in the CG. Subscales of the SF-36 increased significantly in the SG, especially concerning physical functioning by +7.5 (1.3-30.0), emotional role by +33.3 (0-66.6), and social functioning by +18.8 (0-46.9), all P < 0.05. Neither a change nor a decrease was observed in the CG. Neuromuscular electrical stimulation of thigh muscles in patients with refractory heart failure is effective in increasing muscle strength and bulk and positively affects the perception of quality of life and activities of daily living.
Activities of Daily Living↗
Studies in mistletoe therapy and cancer: still waiting for the the big step forward.
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Humans↗
Calcium supplementation with calcium-rich mineral waters: a systematic review and meta-analysis of its bioavailability.
The relevance of calcium (Ca2+), an essential bone mineral, to the prevention and treatment of osteoporosis is well established. However, a good deal of evidence casts doubt on the validity of current RDAs (recommended daily allowance), i.e., 800-1000 mg/day. New guidelines consistently advocate higher daily intakes (up to 1500 mg/day), a goal that may be difficult to achieve for many patients. Environmental as well as individual behavioral factors may limit the consumption of dairy products, whereas calcium supplements require a high level of compliance and cause additional costs. Calcium-rich mineral waters may offer a promising alternative. A systematic literature search was performed (Medline, years 1966-1998) to identify experimental studies on the bioavailability of calcium-rich mineral waters. First, all publications on calcium absorption from mineral waters were identified, and, in a second step, studies comparing calcium absorption from mineral waters with that from dairy products. Four studies fulfilled all inclusion criteria. A meta-analysis based on published p values indicated calcium absorption from mineral waters was significantly higher (p = 0.03) than that from dairy products. Although only few studies with a relatively small number of subjects are available to date, the bioavailability of calcium from calcium-rich mineral waters thus seems to be at least comparable to, and possibly better than, that from dairy products. These results are in keeping with the assumption that calcium-rich mineral water is a useful calcium source to achieve new, higher recommended daily allowances of calcium.
Biological Availability↗
Clinical evidence of subcutaneous CO2 insufflations: a systematic review.
OBJECTIVE: To evaluate the evidence of clinical effectiveness of subcutaneous CO2 insufflations (SCIs). STUDY LOCATION: The entire databases of MEDLINE, EMBASE Excerpta Medica (Field: Rehabilitation and Physical Medicine) and the Cochrane Library were screened for data up to August 1999. In addition, other potentially relevant journals were handsearched and references were checked. STUDY SELECTION: Uncontrolled observational trials (UCOTs) with sample sizes of at least n = 100, and controlled clinical trials (CCTs) and randomized controlled trials (RCTs) were included. Outcomes had to be patient-centered. English-, Czechoslovakian-, and German-language papers were considered. DATA ANALYSIS: For all study types, a criteria-based analysis was performed. For controlled trials only, quality was quantitatively assessed with the Jadad and Maastricht Scales. RESULTS: Thirteen studies (5 RCTs, 2 CCTs, and 6 UCOTs) were included. Mean scores on the Jadad and Maastricht Scales were 2 (Maximum 5) and 37 (Maximum 100), respectively. SCIs were found to be effective in addition to standard physical therapy in "peripheral arterial occlusive disease" (2 RCTs) and "stable angina pectoris" (1 RCT) and superior to sham needling for migraine headaches (1 RCT). There were no differences among SCIs and CO2 gas baths (1 RCT) or combined interventions, including SCIs (2 CCTs). All 6 UCOTs showed marked longitudinal effects. CONCLUSIONS: The low number and quality of the available studies precludes firm conclusions on the clinical effectiveness of SCIs.
Carbon Dioxide↗
Long-term efficacy of radon spa therapy in rheumatoid arthritis--a randomized, sham-controlled study and follow-up.
OBJECTIVE: To quantify the efficacy of a series of baths containing natural radon and carbon dioxide (1.3 kBq/l, 1.6 g carbon dioxide/l on average) versus artificial carbon dioxide baths alone in patients with rheumatoid arthritis. SUBJECTS: Sixty patients participating in an in-patient rehabilitation programme including a series of 15 baths were randomly assigned to two groups. DESIGN: Pain intensity (100 mm visual analogue scale) and functional restrictions [Keitel functional test, Arthritis Impact Measurement Scales (AIMS questionnaire)] were measured at baseline, after completion of treatment and 3 and 6 months thereafter. To investigate whether the overall value of the outcomes was the same in both groups, the overall mean was analysed by Student's t-test for independent samples. RESULTS: The two groups showed a similar baseline situation. After completion of treatment, relevant clinical improvements were observed in both groups, with no notable group differences. However, the follow-up revealed sustained effects in the radon arm, and a return to baseline levels in the sham arm. After 6 months, marked between-group differences were found for both end-points (pain intensity: -16.9%, 95% confidence interval -27.6 to -6.2%; AIMS score: 0.57, 95% confidence interval 0.16 to 0.98). The between-group differences were statistically significant for both overall means (pain intensity, P: = 0.04; AIMS, P: = 0.01). CONCLUSION: Marked short-term improvements in both groups at the end of treatment may have masked potential specific therapeutic effects of radon baths. However, after 6 months of follow-up the effects were lasting only in patients of the radon arm. This suggests that this component of the rehabilitative intervention can induce beneficial long-term effects.
Aged↗
Preliminary experience with 2-octylcyanoacrylate in a pediatric emergency department.
OBJECTIVE: Documentation of use of octylcyanoacrylate adhesives in a pediatric emergency department with reference to patient selection, complications, and parent satisfaction. DESIGN: Retrospective and concurrent chart review of the first 100 patients on which 2-octylcyanoacrylate (2-OCA, Dermabonda) was used in a pediatric emergency department. Additional telephone follow-up was performed for each patient. RESULTS: The average patient age was 4.7 years, average laceration size 1.2 cm. Sixteen percent of wounds were repaired with 2-OCA. Three immediate complications involved a minor dehiscence and two eyelid adhesions. Two wound infections and a patient with hematoma and keloid formation were identified as later complications. The vast majority of parents preferred tissue adhesive repair to sutures. Time in department was reduced from 106 minutes to 69 minutes on average (P < 0.0001, CI 26-52). CONCLUSIONS: Octylcyanoacrylate adhesives performed well in the daily practice of a pediatric emergency department, and were used for a significant percentage of laceration closures. Convenience, average infection rates, and good parental satisfaction make tissue adhesives a valuable addition to our wound closure techniques. Certain pitfalls occurring during early experience with these adhesives can be recognized and avoided.
Adolescent↗
Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial.
A multicentre, randomized clinical trial was undertaken to test the hypothesis that acupuncture is more efficacious than sham control procedure in the prevention of episodic tension-type headache. Fifty subjects were randomized to receive a course of treatment with either brief acupuncture or a sham procedure. Subjects were followed up for 3 months. Changes in headache were assessed by daily diary, the primary outcome measure being the number of days with headache. No significant differences were found between the changes in the two groups for any measure at any time point. Results also show that patient blinding was successful. In conclusion, this study does not provide evidence that this form of acupuncture is effective in the prevention of episodic tension-type headache.
Acupuncture Therapy↗
[Incidence of stomach ruptures after ingestion of sodium bicarbonate-containing or carbonated beverages].
SUBJECT: Spontaneous rupture of the stomach is an uncommon condition with a usually poor prognosis. The questions of pathophysiologic factors and the possible role of carbonated or bicarbonate-containing beverages were addressed. METHODS AND RESULTS: A review of the literature based on a search of MEDLINE (1966-1998) was performed. Using the key word 'stomach rupture', we found 675 publications. 279 publications dealt with etiologic factors 15 of which mentioned the ingestion of bicarbonate preparations. No record of carbonated or bicarbonate-containing beverages as a single etiologic factor could be found. CONCLUSION: These beverages do not seem to play a significant role in the pathogenesis of stomach rupture, whereas in rare cases bicarbonate preparations can cause rupture of the previously overdistended stomach.
Carbonated Beverages↗
[Mineral water or tap water? A systematic analysis of the literature concerning the question of microbial safety].
BACKGROUND: Based on sporadic reports of microbial contamination of mineral waters, it has been recommended that, for safety reasons, particularly immunocompromised patients should drink tap water rather than bottled mineral water. However, in terms of safety, evidence of the clinical consequences may allow a better estimate than a positive in vitro test for contamination. Therefore, we reviewed the literature on documented disease outbreaks due to contaminated mineral and tap waters. MATERIAL AND METHODS: We performed a systematic search of the literature using the database MEDLINE. In order to identify evidence relevant for Germany, we restricted our search to the years 1985-1997 (i.e. legal force of the mineral and table waters act in Germany) and the countries of Central and Northwestern Europe as well as the USA and Canada. RESULTS: Cases of contamination of tap water were documented in nearly all countries included. In 35 communications we found reports on a total of 423,000 cases of disease outbreaks due to contaminated tap water, in some cases even with lethal outcome. Main diagnosis was gastroenteritis, and main species of microorganism was crytosporidium. In contrast, there was no documented case of disease outbreak due to contaminated bottled mineral water. CONCLUSION: Tap water as well as bottled water are both supremely safe components of nutrition. The recommendation that tap water is better than mineral water, particularly for high-risk patients, is not supported by the literature.
Disease Outbreaks↗
[Deciding factor plausibility].
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Complementary Therapies↗
Ultrasound therapy for calcific tendinitis of the shoulder.
BACKGROUND AND METHODS: Although ultrasound therapy is used to treat calcific tendinitis of the shoulder, its efficacy has not been rigorously evaluated. We conducted a randomized, double-blind comparison of ultrasonography and sham insonation in patients with symptomatic calcific tendinitis verified by radiography. Patients were assigned to receive 24 15-minute sessions of either pulsed ultrasound (frequency, 0.89 MHz; intensity, 2.5 W per square centimeter; pulsed mode, 1:4) or an indistinguishable sham treatment to the area over the calcification. The first 15 treatments were given daily (five times per week), and the remainder were given three times a week for three weeks. Randomization was conducted according to shoulders rather than patients, so a patient with bilateral tendinitis might receive either or both therapies. RESULTS: We enrolled 63 consecutive patients (70 shoulders). Fifty-four patients (61 shoulders) completed the study. There were 32 shoulders in the ultrasound-treatment group and 29 in the sham-treatment group. After six weeks of treatment, calcium deposits had resolved in six shoulders (19 percent) in the ultrasound-treatment group and decreased by at least 50 percent in nine shoulders (28 percent), as compared with respective values of zero and three (10 percent) in the sham-treatment group (P=0.003). At the nine-month follow-up visit, calcium deposits had resolved in 13 shoulders (42 percent) in the ultrasound-treatment group and improved in 7 shoulders (23 percent), as compared with respective values of 2 (8 percent) and 3 (12 percent) in the sham-treatment group (P=0.002). At the end of treatment, patients who had received ultrasound treatment had greater decreases in pain and greater improvements in the quality of life than those who had received sham treatment; at nine months, the differences between the groups were no longer significant. CONCLUSIONS: In patients with symptomatic calcific tendinitis of the shoulder, ultrasound treatment helps resolve calcifications and is associated with short-term clinical improvement.
Calcinosis↗
[Migraine and prevention of migraine: the value of magnesium].
Migraine (with and without aura) is characterised by a marked heterogeneity of clinical symptoms. A variety of pathophysiological models has been proposed and a multitude of prophylactic strategies recommended. It appears that prophylaxis is still problematic, despite considerable progress in acute treatment. Most substances used for the former purpose either have substantial side effects or a wide range of contraindications. Magnesium (Mg) seems to play a significant role in the pathogenesis of migraine. A few clinical trials have produced preliminary evidence of therapeutic efficacy. There is a reasonable amount of empirical evidence, and further research is warranted considering its low cost and favourable side effects profile. An attempt at prophylaxis in mild to mid-severe migraine with a daily dose of 600 mg (about 50 mEq) Mg seems to be justified.
Dose-Response Relationship, Drug↗
Reviewer bias against the unconventional? A randomized double-blind study of peer review.
OBJECTIVE: To test the hypothesis that there is a reviewer bias against publication of a test of an unconventional drug. DESIGN: Randomized, controlled, double-blind study of peer review. PARTICIPANTS: Convenience sample of 291 medical doctors from a wide variety of specialties drawn from a list of conference participants. METHODS: Reviewers were randomly assigned to receive one of two versions of a manuscript. Version M related to an in-vitro experiment on a mainstream drug (Metoprolol). The otherwise identical version V used a highly unconventional drug (beef spleen cell extract) for the same experiment. Reviewers were asked to complete a standardised evaluation sheet including visual analogue scales (VASs) on a set of predefined quality criteria. All participants were debriefed after completion of the study. RESULTS: The response rate was 61%. There were no significant differences in VAS ratings between the two versions of the manuscript. Ratings covered the entire range of the VASs. CONCLUSION: In the present setting, there was no evidence for a reviewer-bias against testing an unconventional drug. The low inter-rater reliability, however, suggested inadequate validity of peer review.
Animals↗
A meta-analysis of acupuncture techniques for smoking cessation.
OBJECTIVE: To determine the effectiveness of acupuncture for smoking cessation and to examine whether any individual aspect of trials is associated with an effect. DATA SOURCES: All randomised controlled trials of acupuncture for smoking cessation that were listed in computerised databases or reference lists of relevant articles. STUDY SELECTION: All randomised single-blind studies that compared acupuncture with sham acupuncture. DATA EXTRACTION: Methodological data were extracted for quality assessment. Outcome data were extracted for rates of total smoking cessation at three intervals: early after treatment and after six and 12 months follow up. DATA SYNTHESIS: Results were expressed as odds ratios of success over failure in intervention over control groups. The combined odds ratio for all studies was calculated. Repeated meta-analyses were subsequently performed on subsets of studies combined according to defined characteristics: acupuncture technique, number of attendances, country of origin, status of journal, and control procedure. The overall quality of studies was poor. The combined odds ratio for smoking cessation calculated for the earliest results after the end of treatment was 1.20 (95% confidence intervals (95% CIs) = 0.98 to 1.48). The combined odds ratio for smoking cessation after six months was 1.29 (95% CI = 0.82 to 2.01), and after 12 months was 1.03 (95% CI = 0.73 to 1.46). There were no significant effects of relevance among subsets of studies grouped according to defined characteristics. CONCLUSIONS: Acupuncture was not superior to sham acupuncture for smoking cessation; no particular aspect of acupuncture technique was associated with a positive effect. The conclusions are limited by methodological inadequacies of studies and by the absence of testable hypotheses; design of future trials should avoid these deficiencies.
Acupuncture Therapy↗