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N Smidt

Publications and source records attributed to N Smidt.

15 recordsLinked to original sources
PubMed2006

The quality of diagnostic accuracy studies since the STARD statement: has it improved?

OBJECTIVE: To assess whether the quality of reporting of diagnostic accuracy studies has improved since the publication of the Standards for the Reporting of Diagnostic Accuracy studies (STARD statement). METHODS: The quality of reporting of diagnostic accuracy studies published in 12 medical journals in 2000 (pre-STARD) and 2004 (post-STARD) was evaluated by two reviewers independently. For each article, the number of reported STARD items was counted (range 0 to 25). Differences in completeness of reporting between articles published in 2000 and 2004 were analyzed, using multilevel analyses. RESULTS: We included 124 articles published in 2000 and 141 articles published in 2004. Mean number of reported STARD items was 11.9 (range 3.5 to 19.5) in 2000 and 13.6 (range 4.0 to 21.0) in 2004, an increase of 1.81 items (95% CI: 0.61 to 3.01). Articles published in 2004 reported the following significantly more often: methods for calculating test reproducibility of the index test (16% vs 35%); distribution of the severity of disease and other diagnoses (23% vs 53%); estimates of variability of diagnostic accuracy between subgroups (39% vs 60%); and a flow diagram (2% vs 12%). CONCLUSIONS: The quality of reporting of diagnostic accuracy studies has improved slightly over time, without a more pronounced effect in journals that adopted the STARD statement. As there is still room for improvement, editors should mention the use of the STARD statement as a requirement in their guidelines for authors, and instruct reviewers to check the STARD items. Authors should include a flow diagram in their manuscript.

Diagnostic Techniques and Procedures↗
PubMed2006

Long term health complaints following the Amsterdam Air Disaster in police officers and fire-fighters.

BACKGROUND: On 4 October 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, the Netherlands. Fire-fighters and police officers assisted with the rescue work. OBJECTIVES: To examine the long term health complaints in rescue workers exposed to a disaster. METHODS: A historical cohort study was performed among police officers (n = 834) and fire-fighters (n = 334) who performed at least one disaster related task and reference groups of their non-exposed colleagues (n = 634 and n = 194, respectively). The main outcome measures included digestive, cardiovascular, musculoskeletal, nervous system, airway, skin, post-traumatic stress, fatigue, and general mental health complaints; haematological and biochemical laboratory values; and urinalysis outcomes. RESULTS: Police officers and fire-fighters who were professionally exposed to a disaster reported more physical and mental health complaints, compared to the reference groups. No clinically relevant statistically significant differences in laboratory outcomes were found. CONCLUSIONS: This study is the first to examine long term health complaints in a large sample of rescue workers exposed to a disaster in comparison to reference groups of non-exposed colleagues. Findings show that even in the long term, and in the absence of laboratory abnormalities, rescue workers report more health complaints.

Accidents, Aviation↗
PubMed2005

Shock wave therapy for lateral elbow pain.

BACKGROUND: This review is one in a series of reviews of interventions for lateral elbow pain. OBJECTIVES: To determine the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for lateral elbow pain. SEARCH STRATEGY: Searches of the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2004), MEDLINE, EMBASE, CINAHL, and Science Citation Index (SCISEARCH) were conducted in February 2005, unrestricted by date. SELECTION CRITERIA: We included nine trials that randomised 1006 participants to ESWT or placebo and one trial that randomised 93 participants to ESWT or steroid injection. DATA COLLECTION AND ANALYSIS: For each trial two independent reviewers assessed the methodological quality and extracted data. Methodological quality criteria included appropriate randomisation, allocation concealment, blinding, number lost to follow up and intention to treat analysis. Where appropriate, pooled analyses were performed. If there was significant heterogeneity between studies or the data reported did not allow statistical pooling, individual trial results were described in the text. MAIN RESULTS: Eleven of the 13 pooled analyses found no significant benefit of ESWT over placebo. For example, the weighted mean difference for improvement in pain (on a 100-point scale) from baseline to 4-6 weeks from a pooled analysis of three trials (446 participants) was -9.42 (95% CI -20.70 to 1.86) and the weighted mean difference for improvement in pain (on a 100-point scale) provoked by resisted wrist extension (Thomsen test) from baseline to 12 weeks from a pooled analysis of three trials (455 participants) was -9.04 (95% CI -19.37 to 1.28). Two pooled results favoured ESWT. For example, the pooled relative risk of treatment success (at least 50% improvement in pain with resisted wrist extension at 12 weeks) for ESWT in comparison to placebo from a pooled analysis of two trials (192 participants) was 2.2 (95% CI 1.55 to 3.12). However this finding was not supported by the results of four other individual trials that were unable to be pooled. Steroid injection was more effective than ESWT at 3 months after the end of treatment assessed by a reduction of pain of 50% from baseline (21/25 (84%) versus 29/48 (60%), p<0.05). Minimal adverse effects of ESWT were reported. Most commonly these were transient pain, reddening of the skin and nausea and in most cases did not require treatment discontinuation or dosage adjustment. AUTHORS' CONCLUSIONS: Based upon systematic review of nine placebo-controlled trials involving 1006 participants, there is "Platinum" level evidence that shock wave therapy provides little or no benefit in terms of pain and function in lateral elbow pain. There is "Silver" level evidence based upon one trial involving 93 participants that steroid injection may be more effective than ESWT.

Adult↗
PubMed2005

A comparison of two primary care trials on tennis elbow: issues of external validity.

OBJECTIVE: To assess clinical heterogeneity across two studies with respect to study population, interventions, and outcome measures, and to evaluate the influence of these sources of heterogeneity on the results of the studies. METHODS: The individual patient data were used from two randomised controlled trials investigating the effectiveness of conservative treatments in patients with tennis elbow in primary care. Patients were allocated at random to treatment with steroid injection, wait and see policy, non-steroidal anti-inflammatory drugs, placebo tablets, or physiotherapy. Outcome measures included severity of the main complaint, inconvenience of the elbow complaints, pain during the day, elbow disability, pain-free grip strength, and global improvement. All outcomes were assessed at 1, 6, and 12 months after randomisation. RESULTS: The two study populations were similar with respect to age, sex, comorbid neck/shoulder complaints, and baseline scores for the severity of pain. However, significant differences were observed for employment status, duration of elbow complaints, dominant side affected, previous history of elbow complaints, and use of analgesics. Local injections differed between the two studies with respect to volume, number, and steroid preparation. However, after 1, 6, and 12 months, the treatment effects of steroid injections were very similar between the study populations. CONCLUSIONS: Despite large differences in study population at baseline, the responses to steroid injections were remarkably similar. Also the responses to other conservative interventions and the placebo treatment were very consistent, suggesting a uniform course of a tennis elbow and a lack of influence of clinical heterogeneity.

Adult↗
PubMed2005

Two pragmatic trials of treatment for shoulder disorders in primary care: generalisability, course, and prognostic indicators.

OBJECTIVE: To investigate predictors of long term prognosis in patients treated for shoulder pain in primary care. METHODS: Data were taken from two pragmatic randomised clinical trials investigating the effectiveness of conservative treatments for shoulder pain presenting to primary care. Shoulder pain severity, disability, and perceived recovery measured in the long term (UK, 18 months; Netherlands, 12 months) were considered as outcome measures. Prognostic indicators measured before randomisation were determined by linear regression (pain severity and disability) and logistic regression (perceived recovery). RESULTS: 316 adults with a new episode of shoulder pain were recruited (UK, n = 207; Netherlands, n = 109). In multivariate analysis, greater shoulder disability at follow up was associated with higher baseline disability score, concomitant neck pain, and a gradual onset and longer duration of shoulder symptoms. Pain scores at follow up were higher in women and in those with longer baseline duration of symptoms and higher baseline pain or disability scores. Being female, reporting gradual onset of symptoms, and a higher baseline disability score each independently reduced the likelihood of perceived recovery. CONCLUSIONS: The results suggest that there is no long term difference in outcome between patients with shoulder pain treated with different clinical interventions in different clinical settings, or having different clinical diagnoses. Baseline clinical characteristics of this consulting population, rather than the randomised treatments which they received, were the most powerful predictors of outcome. Whether this highlights the need for earlier intervention or reflects different natural histories of shoulder pain is a topic for further research.

Anti-Inflammatory Agents↗
PubMed2002

Shock wave therapy for lateral elbow pain.

BACKGROUND: This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the elbow and forearm and lack of strength and function of the elbow and wrist. Shock wave therapy (ESWT) involves the application of single pulsed acoustic wave. Since the 1990's reports of benefit of ESWT in the treatment of tendon disorders have been appearing in the literature. A systematic review published in the German language appeared in 2000 (Boddeker 2000) OBJECTIVES: To determine the effectiveness and safety of ESWT in the treatment of adults with lateral elbow pain. SEARCH STRATEGY: Comprehensive electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were combined with searches of the Cochrane Clinical Trails Registrar and the Musculoskeletal Review Group's specialist trial database. Identified keywords and authors were searched again in an effort to identify as many trials as possible. SELECTION CRITERIA: Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were evaluated for inclusion in the review provided they described individuals with lateral elbow pain and were comparing the use of ESWT as a treatment strategy. DATA COLLECTION AND ANALYSIS: For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference. Weighted mean difference using a random effects model was selected when outcomes were measured on standard scales. A fixed effects model was used to interpret results and assess heterogeneity. For binary data numbers of events and total population were analysed and interpreted as relative risk. MAIN RESULTS: Two trials of ESWT versus placebo are included in this review (~~Rompe 1996~~, ~~Haake 2001~~). Both trials included similar study populations consisting of participants with chronic symptoms who had failed other conservative treatment. The frequency of ESWT application and the doses and techniques used were similar in both trials. The first trial demonstrated highly significant differences in favour of ESWT whereas the second trial found no benefits of ESWT over placebo. When the data from the two trials were pooled, the benefits observed in the first trial were no longer statistically significant. The relative risk for treatment failure (defined as Roles-Maudsley score of 4) of ESWT over placebo was 0.40 (95% CI, 0.08 to 1.91) at six weeks and 0.44 (95% CI, 0.09 to 2.17) at one year. After 6 weeks, there was no statistically significant improvement in pain at rest [WMD pain out of 100 = - 11.40 (95% CI, -26.10 to 3.30)], pain with resisted wrist extension [WMD pain out of 100 = -16.20 (95% CI, -47.75 to 15.36)] or pain with resisted middle finger extension [WMD pain out of 100 = -20.51(95% CI, -56.57 to 15.56)]. Results after 12 or 24 weeks were similar. REVIEWER'S CONCLUSIONS: The two trials included in this review yielded conflicting results. Further trials are needed to clarify the value of ESWT for lateral elbow pain.

Adult↗
PubMed2002

Surgery for lateral elbow pain.

BACKGROUND: This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the lateral elbow and forearm and lack of strength and function of the elbow and wrist. Surgery is sometimes recommended in treating chronic cases of lateral elbow pain where other less invasive interventions have failed. Various operations have been described based upon the surgeon's concept of the pathological entity. The most described surgical procedures involve release of the extensor carpi radialis brevis (ECRB) from the lateral epicondyle region based upon the premise that there is pathology in the attachment of ECRB to the lateral epicondyle. No systematic review has previously been published assessing the effect of surgical interventions for lateral elbow pain. OBJECTIVES: To determine the effectiveness of surgical interventions in the treatment of adults with lateral elbow pain. SEARCH STRATEGY: Comprehensive electronic searches of MEDLINE, CINAHL, EMBASE and SCISEARCH were combined with searches of the Cochrane Clinical Trials Registrar and the Musculoskeletal Review Group's specialist trial database. Identified keywords and authors were researched in an effort to identify as many trials as possible. Searches were conducted up to October 2001. SELECTION CRITERIA: Two independent reviewers assessed all identified studies against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were to be included in the review provided they were studying the effects of a surgical intervention and included a control as treatment for adults with lateral elbow pain. The control intervention could comprise no treatment or another intervention including an alternate surgical intervention. Outcomes of interest included pain, function, disability and quality of life, strength and adverse effects. DATA COLLECTION AND ANALYSIS: The planned collection and analysis of data is described. MAIN RESULTS: Our search did not identify any controlled trials investigating the effect of surgery on lateral elbow pain. REVIEWER'S CONCLUSIONS: At this time there are no published controlled trials of surgery for lateral elbow pain. Without a control group, it is not possible to draw any conclusions about the value of this modality of treatment.

Adult↗
PubMed2002

Acupuncture for lateral elbow pain.

BACKGROUND: This review is one in a series of reviews of interventions for lateral elbow pain. Lateral elbow pain, or tennis elbow, is a common condition causing pain in the elbow and forearm and lack of strength and function of the elbow and wrist. Acupuncture has long been used to treat lateral elbow pain in China and in Western countries practitioners and consumers are increasingly exploring acupuncture as a first line treatment for musculoskeletal disorders. No previous systematic review of the available evidence has been conducted to determine whether acupuncture is efficacious in the treatment lateral elbow pain. OBJECTIVES: To determine the effectiveness of acupuncture in the treatment of adults with lateral elbow pain with respect to pain reduction, improvement in function, grip strength and adverse effects. SEARCH STRATEGY: We searched MEDLINE, CINAHL, EMBASE and SCISEARCH and the Cochrane Clinical Trials Register and the Musculoskeletal Review Group's specialist trial database from 1966 to June 2001. Identified keywords and authors were searched in an effort to retrieve as many trials as possible. SELECTION CRITERIA: Two independent reviewers assessed all identified trials against pre-determined inclusion criteria. Randomised and pseudo randomised trials in all languages were included in the review provided they were testing acupuncture compared to placebo or another intervention in adults with lateral elbow pain (tennis elbow). Outcomes of interest were pain, function, disability, quality of life, strength, participant satisfaction with treatment and adverse effect. DATA COLLECTION AND ANALYSIS: For continuous variables means and standard deviations were extracted or imputed to allow the analysis of weighted mean difference, while for binary data numbers of events and total population were analysed and interpreted as relative risks. Trial results were combined only in the absence of clinical and statistical heterogeneity. MAIN RESULTS: Four small randomized controlled trials were included but due to flaws in study designs (particularly small populations, uncertain allocation concealment and substantial loss to follow up) and clinical differences between trials, data from trials could not be combined in a meta-analysis. One randomised controlled trial found that needle acupuncture results in relief of pain for significantly longer than placebo (WMD = 18.8 hours, 95%CI 10.1 to 27.5) and is more likely to result in a 50% or greater reduction in pain after 1 treatment (RR 0.33, 95%CI 0.16 to 0.69) (Molsberger 1994). A second randomized controlled trial demonstrated needle acupuncture to be more likely to result in overall participant reported improvement than placebo in the short term (RR = 0.09 95% CI 0.01 to 0.64) (Haker 1990a). No significant differences were found in the longer term (after 3 or 12 months). A randomized controlled trial of laser acupuncture versus placebo demonstrated no differences between laser acupuncture and placebo with respect to overall benefit (Haker 1990b). A fourth included trial published in Chinese demonstrated no difference between Vitamin B12 injection plus acupuncture, and Vitamin B12 injection alone (Wang 1997). REVIEWER'S CONCLUSIONS: There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral elbow pain. This review has demonstrated needle acupuncture to be of short term benefit with respect to pain, but this finding is based on the results of 2 small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. Further trials, utilising appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis elbow.

Acupuncture Therapy↗
PubMed2002

Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults.

BACKGROUND: Lateral elbow pain, or tennis elbow, is a common condition causing pain in the elbow and forearm and lack of strength and function of the elbow and wrist. It is often treated with non-steroidal anti-inflammatory drugs (NSAIDs), either orally or by topical application. OBJECTIVES: To assess effectiveness of NSAIDs (oral or topical) in the treatment of adults with lateral elbow pain with respect to symptom (pain) reduction, improvement in function, grip strength and adverse effects. SEARCH STRATEGY: We searched the Musculoskeletal Review Group's trials register database, the Cochrane Clinical Trials Register (Cochrane Library issue 2, 2001), MEDLINE, CINAHL, EMBASE and SCISEARCH up to June 2001. SELECTION CRITERIA: Randomised and pseudo randomised trials in all languages of NSAIDs (oral or topical) compared to placebo or another intervention, or comparing two NSAIDs (oral or topical) to each other, in adults with lateral elbow pain (tennis elbow). Outcomes of interest were pain, function, disability and quality of life, strength, participant satisfaction with treatment and adverse effect. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied selection criteria and assessed study quality. MAIN RESULTS: Fourteen trials were included in the review. Few trials used intention to treat analysis, and the sample size of most was small. The median follow up was 2 weeks (range 1-12 weeks). There is evidence that topical NSAIDs are significantly more effective than placebo with respect to pain [weighted main difference= -1.88, (95% confidence intervals -2.54 to -1.21)] and participant satisfaction [relative risk 0.39, (95% confidence intervals 0.23 to 0.66)] in the short term, and this finding is robust against the possible bias introduced by the inclusion of unblinded trials and publication bias. The adverse effects reported were minor. Only two included trials assessed the effect of oral NSAID and these were not able to be pooled. There is some evidence for short term benefit with respect to pain and function from oral NSAIDs, but this benefit was not sustained. Significantly more gastrointestinal adverse effects were reported by those taking oral NSAIDs [relative risk = 3.17, (95% confidence intervals 1.35 to 7.41)]. In the short term there may be some advantage in steroid injection over oral NSAID [patient's perception of benefit relative risk = 3.06, (95% confidence intervals 1.55 to 6.06)], but this was not sustained in the longer term. REVIEWER'S CONCLUSIONS: There is some support for the use of topical NSAIDs to relieve lateral elbow pain at least in the short term. There remains insufficient evidence to recommend or discourage the use of oral NSAID, although it appears injection may be more effective than oral NSAID in the short term. A direct comparison between topical and oral NSAID has not been made and so no conclusions can be drawn regarding the best method of administration.

Administration, Oral↗
PubMed2001

Orthotic devices for tennis elbow.

BACKGROUND: Lateral epicondylitis (tennis elbow) is a frequently reported condition. A wide variety of treatment strategies has been described. As of yet, no optimal strategy has been identified. OBJECTIVES: The objective of this review was to assess the effectiveness of orthotic devices for treatment of tennis elbow. SEARCH STRATEGY: An electronic database search was conducted using Medline, Embase, Cinahl, the Cochrane Controlled Trial Register, Current Contents and reference lists from all retrieved articles. Experts on the subjects were approached for additional trials. SELECTION CRITERIA: All randomised clinical trials (RCT) describing individuals with diagnosed lateral epicondylitis and comparing the use of an orthotic device as a treatment strategy were evaluated for inclusion. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the validity of the included trials and extracted data on relevant outcome measures. Dichotomous outcomes were expressed as Relative Risks (RRs) and continuous outcomes as Standardised Mean Differences (SMD), both with corresponding 95% confidence intervals (95% CI). Statistical pooling and subgroup analyses were intended MAIN RESULTS: Five small-size RCTs (N per group 7-49) were included. Validity score ranged from 3-9 positive items out of 11. Subgroup analyses were not performed due to the small number of trials. The limited number of included trials present few outcome measures and limited long-term results. Pooling was not possible due to large heterogeneity amongst trials. REVIEWER'S CONCLUSIONS: No definitive conclusions can be drawn concerning effectiveness of orthotic devices for lateral epicondylitis. More well-designed and well-conducted RCTs of sufficient power are warranted.

Humans↗
PubMed2001

Orthotic devices for tennis elbow: a systematic review.

Lateral epicondylitis (tennis elbow) is af requently reported condition. A wide variety of treatment strategies has been described. Asy et, no optimal strategy has been identified. The aim of this review was to assess the effectiveness of orthotic devices for treatment of tennis elbow. An electronic database search was conducted using MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trial Register Current Contents, and reference listsf rom all retrieved articles. Experts on the subjects were approachedfor additional trials. All randomised controlled trials (RCTs) descrbiing individuals with diagnosed lateral epicondylitis and assessing the use of an orthotic device as a treatment strategy were evaluatedfor inclusion. Two reviewers independently assessed the validity of the included trials and extracted data on relevant outcome measures. Dichotomous outcomes were expressed as relative risks and continuous outcomes as standardised mean differences, both with corresponding 95% confidence intervals. Statistical pooling and subgroup analyses were intended. Five small-size RCTs (n = 7-49 per group) were included the validity score ranged from three to nine positive items out of 11. Subgroup analyses were not performed owing to the small number of trials. The limited number of included trials present few outcome measures and limited long-term results. Pooling was not possible owing to the high level of heterogeneity of the trials. No definitive conclusions can be drawn concerning effectiveness of orthotic devices for lateral epicondylitis. More well-designed and well-conducted RCTs of sufficient power are warranted.

Evidence-Based Medicine↗
PubMed1981

Sustained release indomethacin: a double blind comparison with indomethacin suppositories.

A double-blind crossover comparison of sustained release indomethacin capsules and indomethacin suppositories showed no efficacy advantage to either preparation. In other respects the two preparations were found to be comparable. More patients preferred the convenience of the oral route of medication when given the choice after the study was concluded.

Administration, Oral↗
PubMed1981

The influence of splenic tissue implantation upon platelet population in rabbits after splenectomy.

An investigation of the behavior of the blood platelet population following splenectomy and autologous splenic tissue implantation has been done on the rabbit. A bimodal rise in platelet size and count is observed in the postoperative period. After splenectomy, a 722 per cent increase in the platelet count and a 21.9 percent rise in the platelet size are found. These increases are abolished by the implantation of splenic tissue. The existence of a splenic humoral factor that controls platelet production in the bone marrow is possible.

Animals↗