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At least 415 records · Page 23Linked to original sources
PubMed1999

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↗
PubMed2001

Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials.

OBJECTIVE: Assessment of the available evidence for the effectiveness of exercise therapy to improve arm function in patients who have suffered from a stroke. METHODS: A systematic search of bibliographical databases and reference checking were performed to identify publications on randomized controlled trials (RCTs) which evaluated the effect of exercise therapy on arm function in stroke patients. The methodological quality was assessed systematically by two raters, based on a standardized list of methodological criteria. Study characteristics, such as the chronicity and severity of impairment of the patient population, the amount and duration of interventions, and specific methodological criteria, were related to reported effects. RESULTS: Thirteen RCTs were identified, six of which reported positive results on an arm function test. In five of these six studies there was a contrast in amount or duration of exercise therapy between groups. Methodological scores ranged from 5 to 15 (maximum possible score: 19 points). CONCLUSION: Insufficient evidence made it impossible to draw definitive conclusions about the effectiveness of exercise therapy on arm function in stroke patients. The difference in results between studies with and without contrast in the amount or duration of exercise therapy between groups suggests that more exercise therapy may be beneficial.

Arm↗
PubMed2000

Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis.

PURPOSE: Recent randomized trials in women with node-positive breast cancer who received systemic treatment report that locoregional radiation therapy improves survival. Previous trials failed to detect a difference in survival that results from its use. A systematic review of randomized trials that examine the effectiveness of locoregional radiation therapy in patients treated by definitive surgery and adjuvant systemic therapy was conducted. METHODS: Randomized trials published between 1967 and 1999 were identified through MEDLINE database, CancerLit database, and reference lists of relevant articles. Relevant data was abstracted. The results of randomized trials were pooled using meta-analyses to estimate the effect of treatment on any recurrence, locoregional recurrence, and mortality. RESULTS: Eighteen trials that involved a total of 6,367 patients were identified. Most trials included both pre- and postmenopausal women with node-positive breast cancer treated with modified radical mastectomy. The type of systemic therapy received, sites irradiated, techniques used, and doses of radiation delivered varied between trials. Data on toxicity were infrequently reported. Radiation was shown to reduce the risk of any recurrence (odds ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.83), local recurrence (odds ratio, 0.25; 95% CI, 0.19 to 0.34), and mortality (odds ratio, 0.83; 95% CI, 0.74 to 0.94). CONCLUSION: Locoregional radiation after surgery in patients treated with systemic therapy reduced mortality. Several questions remain on how these results should be translated into current-day clinical practice.

Breast Neoplasms↗
PubMed2002

Age at diagnosis and outcome for women with ductal carcinoma-in-situ of the breast: a critical review of the literature.

PURPOSE: Patients younger than 35 to 45 years old at the time of diagnosis of invasive breast cancer have been found to have a worse prognosis than older patients in many studies. However, the impact of patient age at diagnosis on the outcome of treatment with either lumpectomy and radiation therapy (RT) or mastectomy for patients with ductal carcinoma-in-situ (DCIS) of the breast has not been extensively analyzed. MATERIALS AND METHODS: Articles addressing the effect of patient age at diagnosis on the outcome of treatment of DCIS with lumpectomy and RT or mastectomy were identified through the MEDLINE and CancerLit databases and reference lists of relevant articles. Studies were reviewed to determine the impact of patient age at diagnosis on clinical and pathologic features of DCIS, the influence of age on outcome after lumpectomy and RT, and the impact of age on outcome after mastectomy. RESULTS: DCIS in younger patients more frequently contains adverse prognostic pathologic factors and extends over a greater distance in the breast than in older patients. In series with adequate follow-up, younger patients treated with lumpectomy and RT had a significantly higher rate of local recurrence than older patients, especially for invasive local recurrences. Some studies have suggested that careful attention to margin status and excising larger volumes of tissue can reduce this difference substantially. No available data show that younger patients have better long-term cancer-free survival rates if treated by mastectomy rather than lumpectomy and RT. CONCLUSION: Successful treatment of younger patients with DCIS with lumpectomy and RT requires careful attention to patient evaluation, selection, and surgical technique. When this is done, age at diagnosis should not be a contraindication to breast-conserving therapy.

Adult↗
PubMed2000

A hybrid on-line ECG segmenting system for long-term monitoring.

This paper introduces a new hybrid ECG beat segmenting system, which can be applied in the processing unit of single-channel, long-term ECG monitors for the on-line segmentation of the ECG signal. Numerous ECG segmentation techniques are already existing and applied, however sufficiently robust and reliable methods currently require more than one ECG signal channel and quite complex computations, which are practically not feasible in stand-alone, low-cost monitors. Our new system approach presents a time domain segmentation technique based on a priori physiological and morphological information of the ECG beat. The segmentation is carried out after classifying the ECG beat, using the linear approximation of the filtered ECG signal and considering the pathophysiological properties as well. The proposed algorithms require moderate computational power, allowing the practical realization in battery powered stand-alone long-term cardiac monitors or small-sized cardiac defibrillators. The prototype version of the system was implemented in Matlab. The test and evaluation of the system was carried out with the help of reference signal databases.

Algorithms↗
PubMed2000

Evaluation of echinacea for treatment of the common cold.

Considered to have immunostimulating activity, echinacea is a widely used phytomedicinal for treatment of the common cold and upper respiratory tract infections (URTIs). We reviewed the literature from the MEDLINE database (January 1966-July 1999), International Pharmaceutical Abstracts (IPA) online database, Cambridge Scientific Abstracts Biological Sciences online database, Alt-Health Watch online database, EMBase CD-ROM database, and references from published articles, reviews, and letters to evaluate evidence from clinical trials of echinacea's purported efficacy for treating or preventing URTIs. Twelve clinical studies published from 1961-1997 concluded that echinacea was efficacious for treating the common cold, but the results are unclear due to inherent flaws in study design. Five trials were published since 1997; two showed that echinacea lacked efficacy for treating and preventing URTI symptoms, and three concluded that it was effective in reducing the frequency, duration, and severity of common cold symptoms. Again, these results are unclear because of methodologic uncertainties, such as small populations and use of noncommercially available, nonstandardized dosage forms. Although evidence for echinacea's efficacy is inconclusive, it appears to be safe. Patients without contraindications to it may not be dissuaded from using an appropriate preparation to treat the common cold.

Clinical Trials as Topic↗
PubMed1998

Locomotion improves children's spatial search: a meta-analytic review.

This meta-analysis quantitatively summarized the developmental influence and the effects of locomotor experience as well as the benefits of locomotor practice, locomotor assistance, and active searching patterns on children's search performance. Based on specific criteria, a search of a database and reference lists identified 19 studies, including 1,029 children (510 boys and 519 girls) from 4 to 144 months of age. Outcome measures of spatial performance were converted to 83 effect sizes that reflected the effects of specific experimental characteristics. Analyses of variance indicated that with older children, locomotor activities are more important to their spatial searching. Locomotor status, searching patterns, locomotor assistance, test conditions, and test reliability were identified as moderator variables. In addition, locomotor training significantly improved children's spatial search. The results supported the hypothesis that children's development of spatial search skills is influenced by locomotor experience.

Age Factors↗
PubMedDate not supplied

PDRD--a computer-based primary care decision support system.

This article identifies the current stage of development and assessment of computer-assisted decision support systems in the domain of general practice. Physician's Desk Reference and Database (PDRD), an electronic medical database, is presented, and a plan for assessment of PDRD is briefly discussed.

Artificial Intelligence↗
PubMed1993

The epidemiology of tuberculosis in Victoria.

AIMS: To describe the epidemiology of Mycobacterium tuberculosis (MTb) in Victoria, Australia. METHODS: We analysed data from the Victorian Mycobacterium Reference Laboratory database and MTb notifications to Health and Community Services Victoria, for the period 1948 to 1992. RESULTS: The annual number of notified tuberculosis cases peaked at 1143 in 1954 and declined to 266 in 1992. The incidence rate decreased from 47 to 6.2 per 100,000 in the same period. The pattern of tuberculosis has changed significantly over the last two decades, reflecting the high prevalence of MTb in recent immigrants, particularly in those from South-East Asia. Among people born overseas the number of cases increased from 40% of notifications in 1970 to 80% in 1990; they are younger, more likely to be female and to have extrapulmonary disease, than their Australian-born counterparts. Between 1987 and 1991, the mean annual incidence of tuberculosis in people born in Australia and South-East Asia respectively was 1.5 and 47.5 per 100,000. People born in Vietnam, Cambodia and the Philippines had rates between 100 and 400 per 100,000. These rates have remained stable during the last six years. Almost 50% of migrant patients presented within five years, and 30% within two years, of arrival in Australia. The estimated mean annual incidence of MTb in homeless men between 1984 and June 1992 was 80 per 100,000. Resistance to all first-line drugs increased from 10.8% of all isolates in 1981 to 14.7% in 1990. The incidence of multi-drug resistant MTb (MDR-MTb) has been consistently less than 2% of isolates per year in the past 15 years. There were 14 cases of MTb and HIV between 1985 and June 1992. The mean annual incidence of MTb in people with AIDS is 1579 per 100,000 (range, 570-2420 per 100,000), with a relative risk of 236 (95% confidence interval [CI], 134-414). MDR-MTb has not been documented in HIV-infected individuals in Victoria. CONCLUSION: Tuberculosis remains an important public health concern. Groups at high risk include people born overseas, the homeless, and people infected with HIV. Physicians caring for AIDS patients should consider the diagnosis of MTb, since its incidence in AIDS patients is so high. Our data suggest possible shortcomings in current methods of screening and prophylactic treatment of migrants and refugees. The rising rate of drug resistance cannot be ignored. We should consider strategies to ensure judicious use of anti-tuberculous drugs by physicians, and optimal patient compliance. These issues are critical to the future of tuberculosis control in Victoria.

Adolescent↗
PubMed2002

Postmenopausal estrogen replacement and risk for venous thromboembolism: a systematic review and meta-analysis for the U.S. Preventive Services Task Force.

BACKGROUND: Postmenopausal estrogen replacement is widely used in the United States but poses important health risks. PURPOSE: To assess the risk for venous thromboembolism with postmenopausal estrogen replacement by using literature review and meta-analysis. DATA SOURCES: All relevant English-language studies identified in searches of the MEDLINE (1966 to December 2000), HealthSTAR (1975 to December 2000), and Cochrane Library databases, and references lists of key articles. STUDY SELECTION: All published studies of postmenopausal estrogen replacement reporting venous thromboembolism as an outcome or adverse event. DATA EXTRACTION: 12 studies of estrogen were identified (3 randomized, controlled trials; 8 case-control studies; and 1 cohort study). Data were extracted on participants, interventions, event rates, and confounders. Two reviewers independently rated study quality on the basis of established criteria. DATA SYNTHESIS: A Bayesian meta-analysis was conducted. When data from all studies were pooled, current estrogen use was associated with an increased risk for venous thromboembolism (relative risk, 2.14 [95% credible interval, 1.64 to 2.81]). Estimates did not significantly change when studies were pooled according to study design, quality score, or whether participants had preexisting coronary artery disease. The absolute rate increase was 1.5 venous thromboembolic events per 10 000 women in 1 year. Six case-control studies that reported risk according to duration of use found that risk was highest in the first year of use (relative risk, 3.49 [credible interval, 2.33 to 5.59]). CONCLUSION: Postmenopausal estrogen replacement is associated with an increased risk for venous thromboembolism, and this risk may be highest in the first year of use.

Bayes Theorem↗
PubMed1999

Hoarding: a review.

BACKGROUND: Hoarding is currently categorized as a symptom of both obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder. However, hoarding has also been documented in association with other psychiatric disorders, raising questions about the classification, psychobiology and treatment of these symptoms. This paper reviews the literature on hoarding. METHOD: A computerized literature search was done using the MEDLINE database. Relevant references were collated and were used to obtain additional literature on hoarding behavior. RESULTS: Although hoarding may meet DSM-IV diagnostic criteria for a compulsion, this symptom is also seen in a range of other disorders. Nevertheless, the phenomenology of hoarding remains under-researched. In addition, the psychobiology and treatment of hoarding remains relatively poorly understood, although in certain aspects there may be some overlap with the symptoms of OCD. CONCLUSIONS: Further research on the phenomenology, psychobiology and treatment of hoarding is clearly needed. A neuro-ethological view of hoarding as a spectrum symptom seen not only in OCD, but also in other disorders, may provide a useful heuristic for current clinical practice and for future empirical research.

Adolescent↗
PubMed1999

[Are children and adolescents less physically active today than in the past?].

In recent years it has been claimed that Norwegian children and youth have reduced their level of physical activity and fitness. The aim of this systematic review was to investigate whether the amount of physical activity or level of physical fitness have changed among Norwegian children and youth during the past decades. We searched for relevant information in databases and reference lists and established contacts with scientists working in this field. The quality of the studies was evaluated on the basis of selection bias, information bias and adequate reporting of results. Five repeated cross-sectional studies of healthy boys and girls in the period from 1950 to 1997 were included. Three are based on tests of physical fitness and two of self-reported physical activity. The studies indicate that the physical fitness of the older boys has been reduced, the level of activity has been lowered, the percentage of inactive youth has increased and there are now larger variations in physical fitness. We conclude that there seems to be a negative trend in the level of physical fitness and physical activity of children and youth. This shows the need for interventions. The need for standardised parameters for physical activity is apparent.

Adolescent↗
PubMed1999

Review of objective topographic facial nerve evaluation methods.

OBJECTIVE: This study is a critical review of the described methods for objective topographic evaluation of facial nerve function to identify areas of consensus and point to future research topics. SOURCES AND STUDY SELECTION: Original research articles on the subject were identified through the Medline database and reference cross-checking. DATA EXTRACTION AND SYNTHESIS: The articles were grouped according to the methodology used for topographic facial nerve evaluation. The advantages and shortcomings of each method are evaluated. The results obtained in each publication are presented in light of the method used. CONCLUSION: Measurements localized around the facial area under investigation show maximal displacement, whereas other sites exhibit much smaller displacements. Large displacements in these locations can be used to assess synkinesis and contractures. Large intersubject variability of the same measure is found. Both linear measurement and image-subtracting techniques hold promise. but until comparative studies are performed, the best method will remain controversial. Simple systems, accurately evaluating facial motor function, are yet to be developed.

Anthropometry↗
PubMed1999

Cervical ripening and labor induction with a controlled-release dinoprostone vaginal insert: a meta-analysis.

OBJECTIVE: To systematically review published randomized trials that compared efficacy of a 10-mg, controlled-release dinoprostone vaginal insert with other prostaglandins for cervical ripening and labor induction. DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify randomized clinical trials of dinoprostone vaginal inserts for cervical ripening and labor induction. METHODS OF STUDY SELECTION: We evaluated, abstracted data, and assessed the quality of randomized clinical trials on the efficacy of dinoprostone vaginal inserts as cervical ripening and labor induction agents. Only published randomized trials were included in this meta-analysis. TABULATION, INTEGRATION, AND RESULTS: Seventeen studies were identified, eight of which met our criteria for metaanalysis. Those eight trials included 964 subjects, 490 of whom were allocated to dinoprostone vaginal inserts and 474 to other prostaglandin (PG) preparations. We calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using a random- and fixed-effects model. Continuous outcomes were pooled using a variance-weighted average of within-study difference in means. Compared with women who received other PG preparations, those who received dinoprostone vaginal inserts had lower incidence of vaginal delivery within 12 hours of PG application (OR 0.55, 95% confidence interval 0.39, 0.79). Vaginal inserts were associated with longer intervals to vaginal delivery and lower rates of active labor. There were no differences in cesarean delivery rates, incidence of hyperstimulation, or need for oxytocin augmentation between dinoprostone and other PGs. CONCLUSION: Dinoprostone vaginal insert was less effective than other prostaglandins for cervical ripening and labor induction.

Administration, Intravaginal↗
PubMed2000

Medical oxygen and air travel.

This report responds to a resolution that asked the American Medical Association (AMA) to take action to improve airport and airline accommodations for passengers requiring medical oxygen. Information for the report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with experts in aerospace and emergency medicine. Based on this information, the AMA Council on Scientific Affairs determined that commercial air travel exposes passengers to altitude-related hypoxia and gas expansion, which may cause some passengers to experience significant symptoms and medical complications during flight. Medical guidelines are available to help physicians evaluate and counsel potential passengers who are at increased risk of inflight hypoxemia. Supplemental oxygen may be needed for some passengers to maintain adequate tissue oxygenation and prevent hypoxemic complications. For safety and security reasons, federal regulations prohibit travelers from using their own portable oxygen system onboard commercial aircraft. Many U.S. airlines supply medical oxygen for use during flight but policies and procedures vary. Oxygen-dependent passengers must make additional arrangements for the use of supplemental oxygen in airports. Uniform standards are needed to specify procedures and equipment for the use of medical oxygen in airports and aboard commercial aircraft. Revision of federal regulations should be considered to accommodate oxygen-dependent passengers and permit them to have an uninterrupted source of oxygen from departure to destination.

Aircraft↗
PubMed2000

Inflight medical emergencies.

This report responds to resolutions asking the American Medical Association (AMA) to develop recommendations for the use of medical equipment and technology onboard commercial airlines. Information for the report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with experts in aerospace and emergency medicine. Based on this information, the AMA Council on Scientific Affairs determined that, while inflight morbidity and mortality are uncommon, serious events do occur, which require immediate emergency care. Management of serious problems requires an integrated emergency response system that ensures rapid notification of medical personnel on the ground, assistance from appropriately trained flight crews and passenger volunteers (if available), and adequate medical supplies and equipment to stabilize the victim. Physicians have an important role in the preflight evaluation and counseling of potential passengers who are at risk of inflight medical complications, and in providing inflight medical assistance. Some U.S. and foreign air carriers are upgrading inflight emergency medical kits and placing automated external defibrillators aboard aircraft. Few data are available regarding the effectiveness of such improvements in improving health or survival outcomes. Recent federal legislation requires assessment of the extent of inflight medical emergencies, including the adequacy of emergency medical supplies and equipment carried onboard commercial airliners. This legislation also should alleviate liability concerns by providing immunity for physicians and others who render inflight medical assistance.

Aerospace Medicine↗
PubMed2000

Hand motion assessment and rehabilitation system.

Along with the rapid development of information technology, computers play an increasingly prominent and important role. One current trend is to use computers as instruments for physical rehabilitation. In this study, we introduce a new hand motion assessment and rehabilitation system. This system assesses a user's grip strength and records the sudden changes in air pressure through a circuit and A/D adapter. A PC interface transforms and saves the data in a data record file. The data is then compiled and combined with a patient's case history and keyed into a database as reference for clinical use. The system is highly efficient, cheap and convenient to use. Doctors can use it to monitor and analyze the progress of a rehabilitation program.

Athletic Injuries↗
PubMed2002

Meta-analysis of the effectiveness of parenting programmes in improving maternal psychosocial health.

The purpose of this study was to determine whether group-based parenting programmes are effective in improving maternal psychosocial health. Data sources used were English and non-English language articles published between January 1970 and July 2000, retrieved using a keyword search of a number of biomedical, social science, educational, and general reference electronic databases. Two independent reviewers selected the relevant abstracts and articles. Only controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme and one standardised instrument measuring maternal psychosocial health. Means, standard deviations, and information regarding study quality were selected from the included studies by two independent reviewers. The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to produce an effect size. The results were then combined in a meta-analysis using a fixed-effect model. A total of 23 studies met all the inclusion criteria and 17 of these provided sufficient data with which to calculate effect sizes. Fifteen of these studies provided data on the five main outcomes of interest: depression, anxiety/stress, self-esteem, social support, and relationship with partner. The meta-analyses show statistically significant results favouring the intervention group for depression (-0.3, 95% confidence interval [CI] = -0.4 to -0.1), anxiety/stress (-0.5, 95% CI = -0.7 to -0.3), self-esteem (-0.4, 95% CI = -0.6 to -0.1), and relationship with partner (-0.4, 95% CI = -0.7 to -0.2). However, the meta-analysis of the social support data showed no evidence of effectiveness (-0.04, 95% CI = -0.3 to 0.2). Follow-up data were available for only three of the five outcomes. The results show that there were changes favouring the intervention group for self-esteem (-0.4, 95% CI = -0.7 to -0.2), the mother's relationship with her partner (-0.3, 95% CI = -0.8 to 0.1), and depression (-0.2, 95% CI = -0.4 to 0.002), although the confidence intervals for the mother's relationship with her partner and depression both cross zero. It is concluded that parenting programmes can make a significant contribution to the short-term psychosocial health of mothers. While the limited follow-up data are promising, further evidence of their effectiveness in improving maternal mental health is required. It is also suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present.

Anxiety↗