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PubMed1996

A systematic review of physical activity promotion strategies.

We have reviewed randomised controlled trials of physical activity promotion to provide recent and reliable information on the effectiveness of physical activity promotion. Computerised databases and references of references were searched. Experts were contacted and asked for information about existing work. Studies assessed were randomised controlled trials of healthy, free living, adult subjects, where exercise behaviour was the dependent variable. Eleven trials were identified. No United Kingdom based studies were found. Interventions that encourage walking and do not require attendance at a facility are most likely to lead to sustainable increases in overall physical activity. Brisk walking has the greatest potential for increasing overall activity levels of a sedentary population and meeting current public health recommendations. The small number of trials limits the strength of any conclusions and highlights the need for more research.

Adult↗
PubMed1996

Prevalence of potentially inappropriate long term prescribing in general practice in the United Kingdom, 1980-95: systematic literature review.

OBJECTIVE: To determine the prevalence of potentially inappropriate long term prescribing in general practice in the United Kingdom. DESIGN: Review of 62 studies of the appropriateness of prescribing identified from seven electronic databases, from reference lists, and by hand searching of journals. A nominal group of 10 experts helped to define the appropriateness of prescribing. SETTING: General practice in the United Kingdom. MAIN OUTCOME MEASURES: Prevalences of 19 indicators of inappropriate long term prescribing representing five dimensions: indication, choice of drug, drug administration, communication, and review. RESULTS: Prevalences of potentially inappropriate prescribing varied by indicator and chronic condition, but drug dosages outside the therapeutic range consistently recorded the highest rates. The lowest rates were generally associated with indicators of the choice of the drug, except cost minimisation. Communication is studied less frequently than other dimensions of prescribing appropriateness. CONCLUSIONS: The evidence base to support allegations of widespread inappropriate prescribing in general practice is unsound. Although inappropriate prescribing has occurred, the scale of the problem is unknown because of limitations associated with selection of a standard, publication bias, and uncertainty about the context of prescribing decisions. Opportunities for cost savings and effectiveness gains are thus unclear. Indicators applicable to individual patients could yield evidence of prescribing appropriateness.

Communication↗
PubMed2000

A systematic review of treatments for settling problems and night waking in young children.

OBJECTIVES: To assess the efficacy of treatments for settling problems and night waking in young children. DESIGN: A systematic review of randomised controlled trials of interventions for settling problems and night waking in young children. SETTING: Electronic bibliographic databases and references on identified papers, hand searches, and personal contact with specialists. SUBJECTS: Children aged 5 years or less who had established settling problems or night waking. INTERVENTIONS: Interventions had to be described and a placebo, waiting list, or another intervention needed to have been used as a comparison. Interventions comprised drug trials or non-drug trials. MAIN OUTCOME MEASURES: Number of wakes at night, time to settle, or number of nights in which these problems occurred. RESULTS: Drugs seemed to be effective in treating night waking in the short term, but long term efficacy was questionable. In contrast, specific behavioural interventions showed both short term efficacy and possible longer term effects for dealing with settling problems and night waking. CONCLUSIONS: Given the prevalence and persistence of childhood sleep problems and the effects they can have on children and families, treatments that offer long lasting benefits are appealing and these are likely to be behavioural interventions.

Behavior Therapy↗
PubMed2003

Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer.

OBJECTIVE: To review the evidence for the use of bisphosphonates to reduce skeletal morbidity in cancer patients with bone metastases. DATA SOURCES: Electronic databases, scanning reference lists, and consultation with experts and pharmaceutical companies. Foreign language papers were included. STUDY SELECTION: Included trials were randomised controlled trials of patients with malignant disease and bone metastases who were treated with oral or intravenous bisphosphonate compared with another bisphosphonate, placebo, or standard care. All trials measured at least one outcome of skeletal morbidity. RESULTS: 95 articles were identified; 30 studies fulfilled inclusion criteria. In studies that lasted > or = 6 months, compared with placebo bisphosphonates significantly reduced the odds ratio for fractures (vertebral 0.69, 95% confidence interval 0.57 to 0.84, P < 0.0001; non-vertebral 0.65, 0.54 to 0.79, P < 0.0001; combined 0.65, 0.55 to 0.78, P < 0.0001), radiotherapy (0.67, 0.57 to 0.79, P < 0.0001), and hypercalcaemia (0.54, 0.36 to 0.81, P = 0.003) but not for orthopaedic surgery (0.70, 0.46 to 1.05, P = 0.086) or spinal cord compression (0.71, 0.47 to 1.08, P = 0.113). The reduction in orthopaedic surgery was significant in studies that lasted over a year (0.59, 0.39 to 0.88, P = 0.009). Use of bisphosphonates significantly increased time to first skeletal related event but did not increase survival. Subanalyses showed that most evidence supports use of intravenous aminobisphosphonates. CONCLUSIONS: In people with metastatic bone disease bisphosphonates significantly decrease skeletal morbidity, except for spinal cord compression and increased time to first skeletal related event. Treatment should start when bone metastases are diagnosed and continue until it is no longer clinically relevant.

Bone Neoplasms↗
PubMed2000

A systematic review of treatment of settling problems and night waking in young children

OBJECTIVE: To assess the efficacy of treatment of settling problems and night waking in young children. DESIGN: A systematic review of randomized controlled trials of interventions. SETTING: Electronic bibliographic databases and references on identified papers, hand searches, and personal contact with specialists. SUBJECTS: Children aged 5 years or younger who had established settling problems or night waking. INTERVENTIONS: Interventions had to be described and a placebo, waiting list, or another intervention needed to have been used as a comparison. Interventions comprised drug trials or nondrug trials. Main outcome measures Number of wakes at night, time to settle, or number of nights in which these problems occurred. RESULTS: Drugs seemed to be effective in treating night waking in the short term, but long-term efficacy was questionable. In contrast, specific behavioral interventions showed both short-term efficacy and possible longer term effects for dealing with settling problems and night walking. CONCLUSIONS: Given the prevalence and persistence of childhood sleep problems and the effects they can have no children and families, treatments that offer long-lasting benefits are more appealing, and these are likely to be behavioral interventions.

Journal Article↗
PubMed1995

Randomised controlled trials of physical activity promotion in free living populations: a review.

OBJECTIVES: To review evidence on the effectiveness of trials of physical activity promotion in healthy, free living adults. To identify the more effective intervention programmes. METHODS: Computerised databases and references were searched. Experts were contacted and asked for information about existing work. INCLUSION CRITERIA: Randomised controlled trials of healthy, free living adult subjects, where exercise behaviour was the dependent variable were included. CONCLUSIONS: Ten trials were identified. The small number of trials limits the strength of any conclusions and highlights the need for more research. No UK based studies were found. Previously sedentary adults can increase activity levels and sustain them. Promotion of these changes requires personal instruction, continued support, and exercise of moderate intensity which does not depend on attendance at a facility. The exercise should be easily included into an existing lifestyle and should be enjoyable. Walking is the exercise most likely to fulfil these criteria.

Adult↗
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↗
PubMed2003

The psychosocial impact of the implantable cardioverter defibrillator: a meta-analytic review.

OBJECTIVE: The implantable cardioverter defibrillator (ICD) has become the treatment of choice for ventricular arrhythmia (VA; abnormal heart rhythms) and the prevention of sudden cardiac death (SCD). Recent clinical trials have shown the ICD to be superior to anti-arrhythmic medication in reducing mortality; however, research has suggested that ICD recipients experience poor psychosocial adjustment following implantation of the device. This aim of this study was to identify the key psychological characteristics associated with ICD implantation and to establish whether poor psychosocial outcome can be attributed directly to the device and its therapy. METHOD: Studies which reported valid and reliable measures of psychological functioning in ICD patients and appropriate comparison groups were considered for inclusion in a meta-analytic review. A systematic search of electronic databases and reference lists identified 20 studies which fulfilled the inclusion criteria. RESULTS: There were no significant differences in psychosocial outcome between ICD patients and drug-maintained VA patients or between pre- and post-implant ICD patients. However, ICD patients reported significantly worse psychological functioning and physical functioning than other cardiac controls. CONCLUSION: These findings suggest that poor psychosocial outcome in ICD patients may occur as a result of variables associated with the underlying VA condition, rather than as a direct response to implantation of the device and its therapy. This holds important implications for the development and implementation of psychological interventions for patients experiencing VA, in preference to ICD-specific programmes.

Adaptation, Psychological↗
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↗