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PubMed2006

Melanoma, Parkinson's disease and levodopa: causal or spurious link? A review of the literature.

Since the early 1970s, a number of case reports have suggested that levodopa therapy for Parkinson's disease increases the risk of cutaneous malignant melanoma. As yet, no formal epidemiological study has been conducted to verify this hypothesis. To elucidate the relationship between levodopa and the risk of cutaneous malignant melanoma, a systematic literature search using computerized bibliographic databases was done. This review presents the case history evidence for and against the hypothesis of a causal association, and explores possible epidemiological, genetic, social, biochemical and toxicological factors that may increase the risk of melanoma in Parkinson's disease patients. All the case reports in the literature were considered. We concluded that (1) there is no epidemiological or experimental evidence of a causal role of levodopa in increasing the risk of melanoma incidence or progression; (2) there is good evidence of an excess risk of melanoma in patients with Parkinson's disease; (3) there is good evidence of a protective effect of tobacco smoking on the risk for Parkinson's disease; (4) there is good evidence of positive correlation between social class and melanoma risk; (5) the relationship between the risk of Parkinson's disease and the risk of melanoma may be due to a common genetic profile or it can be attributed to a confounding role of social class, associated with both melanoma and Parkinson's disease possibly through an inverse relationship with tobacco smoking.

Animals↗
PubMed2006

Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials.

PURPOSE: To quantify effectiveness of lifestyle interventions for hypertension. DATA SOURCES: Electronic bibliographic databases from 1998 onwards, existing guidelines, systematic reviews. STUDY SELECTION AND DATA ABSTRACTION: We included randomized, controlled trials with at least 8 weeks' follow-up, comparing lifestyle with control interventions, enrolling adults with blood pressure at least 140/85 mmHg. Primary outcome measures were systolic and diastolic blood pressure. Two independent reviewers selected trials and abstracted data; differences were resolved by discussion. RESULTS: We categorized trials by type of intervention and used random effects meta-analysis to combine mean differences between endpoint blood pressure in treatment and control groups in 105 trials randomizing 6805 participants. Robust statistically significant effects were found for improved diet, aerobic exercise, alcohol and sodium restriction, and fish oil supplements: mean reductions in systolic blood pressure of 5.0 mmHg [95% confidence interval (CI): 3.1-7.0], 4.6 mmHg (95% CI: 2.0-7.1), 3.8 mmHg (95% CI: 1.4-6.1), 3.6 mmHg (95% CI: 2.5-4.6) and 2.3 mmHg (95% CI: 0.2-4.3), respectively, with corresponding reductions in diastolic blood pressure. Relaxation significantly reduced blood pressure only when compared with non-intervention controls. We found no robust evidence of any important effect on blood pressure of potassium, magnesium or calcium supplements. CONCLUSIONS: Patients with elevated blood pressure should follow a weight-reducing diet, take regular exercise, and restrict alcohol and salt intake. Available evidence does not support relaxation therapies, calcium, magnesium or potassium supplements to reduce blood pressure.

Administrative Personnel↗
PubMed2006

Effectiveness of upper and lower limb casting and orthoses in children with cerebral palsy: an overview of review articles.

The objective of this overview is to summarize from systematic reviews the evidence on the effectiveness of using upper and lower limb casting or orthoses in children with cerebral palsy. We used computerized bibliographic databases to search for systematic reviews without any language restrictions. Identification, selection, quality assessment, and data extraction were performed independently by two investigators. Of the 40 identified reviews, 23 were selected for closer consideration, and five reviews met the inclusion criteria. The quality of existing systematic reviews and original studies included in our reviews varied widely. The following evidence was found: (1) casting of lower limbs has a short-term effect on passive range of movement; (2) orthoses that restrict ankle plantar flexion have a favorable effect on an equinus walk, but the long-term clinical significance is unclear; (3) evidence on managing upper limb problems with casting or splinting in children with cerebral palsy is inconclusive. Our conclusion is that there is a paucity of evidence from primary studies on the use of orthoses in children with cerebral palsy. More original, well-designed research is needed.

Activities of Daily Living↗
PubMed1998

A decision analytic approach to commissioning ambulance cardiac services.

The paper discusses how a decision analytic framework has been used by an English health authority in relation to the commissioning of ambulance cardiac services. Strategies for the management by ambulance personnel of victims of cardiac arrest and persons with acute chest pain of cardiac origin were modelled in a decision-event tree, and a bibliographic database established. The international research literature prior to 1997 was searched in order to derive probability values for the tree. However, after checking whether the subgroupings of results in the papers were in accordance with the variables in the tree, the number of useful papers on acute chest pain was found to be only two. In the almost complete absence of information--even from small observational studies--on the management of the great majority of patients with cardiac symptoms transported by ambulance, the local ambulance service and the main providers of hospital services in the district are now collaborating in field studies of cardiac care in order to improve the inputs into the model.

Algorithms↗
PubMed2002

Biological data integration: wrapping data and tools.

Nowadays scientific data is inevitably digital and stored in a wide variety of formats in heterogeneous systems. Scientists need to access an integrated view of remote or local heterogeneous data sources with advanced data accessing, analyzing, and visualization tools. Building a digital library for scientific data requires accessing and manipulating data extracted from flat files or databases, documents retrieved from the Web as well as data generated by software. We present an approach to wrapping web data sources, databases, flat files, or data generated by tools through a database view mechanism. Generally, a wrapper has two tasks: it first sends a query to the source to retrieve data and, second builds the expected output with respect to the virtual structure. Our wrappers are composed of a retrieval component based on an intermediate object view mechanism called search views mapping the source capabilities to attributes, and an eXtensible Markup Language (XML) engine, respectively, to perform these two tasks. The originality of the approach consists of: 1) a generic view mechanism to access seamlessly data sources with limited capabilities and 2) the ability to wrap data sources as well as the useful specific tools they may provide. Our approach has been developed and demonstrated as part of the multidatabase system supporting queries via uniform object protocol model (OPM) interfaces.

Algorithms↗
PubMed2004

Systematic review of the literature on postpartum care: methodology and literature search results.

BACKGROUND: The postpartum period is a time for multiple clinical interventions. To date, no critical review of these interventions exists. This systematic review examined evidence for the effectiveness of postpartum interventions that have been reported in the literature. METHODS: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women that were conducted in North America, Europe, Australia, or New Zealand. The initial literature search was done in 1999, using postpartum content search terms, and was enhanced in 2003. In both years, bibliographic databases were searched from their inception. Studies were categorized into key topic areas. Data extraction forms were developed and completed for each study, and the quality of each study was systematically reviewed. Groups of studies in a topic area were reviewed together, and clinically relevant questions emanating from the studies were identified to determine whether the studies, alone or together, provided evidence to support the clinical intervention. RESULTS: In the 1999 search, of 671 studies identified, 140 studies were randomized controlled trials that met the selection criteria: 41 studies related to breastfeeding, 33 to postpartum perineal pain management, and 63 to 11 other key topic areas (Papanicolaou test, rubella immunization, contraception, postpartum support, early discharge, postpartum depression and anxiety, postpartum medical disorders, smoking cessation, nutrition supplements other than breastfeeding, effects of pelvic floor exercise, and effects of early newborn contact). The results of the systematic review of each topic will be summarized in separate papers as they are completed. CONCLUSIONS: This systematic search has identified key topic areas in postpartum care for which randomized controlled trials have been conducted. Our ultimate goal is to provide evidence-based guidelines on the use of routine postpartum interventions.

Breast Feeding↗
PubMed2005

High parity and adverse birth outcomes: exploring the maze.

BACKGROUND: Despite extensive literature on the topic, it is uncertain if grand (para > or = 5) and great grand (para > or = 10) multiparity are associated with adverse birth outcomes. We critically evaluate the evidence for and against the existence of adverse maternal and/or fetal outcomes in high parity women. METHODS: An electronic search of MEDLINE and other bibliographic databases (Current Contents, EMBASE, and CAB) was conducted, and all relevant articles in English language were retrieved. RESULTS: Findings on the association between high parity and maternal-fetal birth outcomes are not consistent. Although the older literature tends to suggest that multiparity is a risk factor for negative birth outcomes, more recent reports are not supportive. Comparison across studies was further complicated by confounding factors like maternal age, socioeconomic status, and levels of prenatal care, as well as by variations in study designs and in the definition of parity itself. Furthermore, most studies that examined women of extreme parity (para > or = 10) were handicapped by inadequate power. CONCLUSIONS: After accounting for quality, culture, and degrees of associations, the preponderance of evidence seems to point to possible existence of heightened risk for certain medical complications and placental pathologies among women of extreme parity. The literature also provides reasonable evidence for a higher-than-expected likelihood for occurrence of fetal macrosomia with advanced parity.

Female↗
PubMed2005

Polypharmacy in the elderly: a literature review.

PURPOSE: To review the body of literature addressing polypharmacy in individuals aged 60 years and older to (a) determine primary care providers' definition of polypharmacy, (b) explore how polypharmacy was assessed in primary care, and (c) seek tested interventions that address polypharmacy. DATA SOURCES: A systematic review of electronic bibliographic databases (e.g. EBSCOHost, InfoTrac, OVID, FirstSearch, and FirstSearch Deluxe) utilizing the search terms "polypharmacy," "polypharmacy and elderly," "polypharmacy and research," and "multiple medications" for the period January 1991 to October 2003 was completed. The search was supplemented with online site searches of relevant journals and review of reference lists of each article. CONCLUSIONS: Results of the literature review revealed that polypharmacy continues to be a significant issue and little research has been conducted regarding the methods primary care providers utilize to assess polypharmacy. Also, there is a gap in the literature regarding the interventions implemented by primary care providers to address polypharmacy. IMPLICATIONS FOR PRACTICE: The following definition of polypharmacy in clinical practice might be more practical: the use of medications that are not clinically indicated. Selecting appropriate limits for numbers of medications may be counterproductive in populations with multiple comorbidities.

Aged↗
PubMed2005

European Union scientific production on alcohol and drug misuse (1976-2000).

BACKGROUND: Alcohol and drug misuse is a social and health phenomenon of great relevance in the European Union (EU). One indicator of scientific production in a given area is the analysis of publications included in bibliographic databases. Scientific production on alcohol and drug misuse was analysed in EU member countries, and comparisons were made between countries. METHODS: Analysis of articles on alcohol and drug misuse published during the period 1976-2000 by institutions based in a country of the EU, indexed by PsycINFO. RESULTS: A total of 4825 citations was retrieved. Great Britain published 38.6%, while Sweden, Germany and Spain accounted for a further 30%. The articles dealt with drug and alcohol usage (12.8%), substance abuse (53.5%) and drug and alcohol rehabilitation (34.5%). The articles were published in 13 different languages, more than three-quarters being in English. Spanish was the second language, and was followed by French, German, Dutch and Italian. The articles were published in 521 different journals, and 62 of these published more than 10 articles. The journals publishing most were Addiction, Alcohol and Alcoholism and Drug and Alcohol Dependence. Sixty-eight per cent of the articles were signed by more than one author, and the index of collaboration, between 1996 and 2000, was 3.24. DISCUSSION AND CONCLUSIONS: PsycINFO is useful for making comparisons between countries, because it includes the name and country of the institution. The number of publications in the EU on alcohol and drug misuse increased over the quarter-century analysed. The most used language was English, as it also is for PsycINFO as a whole, and a tendency towards its increased use was observed. Classification of the articles by subject by the Classification Code is too general, and makes it difficult to distinguish between the areas it proposes. Production tends to be concentrated in journals dealing specifically with drug dependence and psychiatry. The index of collaboration is similar to that found in other scientific areas.

Bibliometrics↗
PubMed2004

Systematic review: the epidemiology of ischaemic colitis.

BACKGROUND: Ischaemic colitis has been associated with co-morbid conditions, medications, vascular surgery and advanced age in case reports and case series. Few data exist on the baseline incidence in the general population or on the increased risk imposed by these risk factors. AIM: To systematically review the literature regarding the incidence, prevalence and risk factors for ischaemic colitis. METHODS: Searches of bibliographic databases were performed independently by two investigators. Studies were included if they used population-based samples, disease-specific population samples or case-control population-based samples of adults with ischaemic colitis, and reported the incidence, prevalence or risk factors for ischaemic colitis. Eligible articles were reviewed and data were abstracted in a duplicate, independent manner. RESULTS: Four studies were identified that reported the general population incidence and four that reported the disease-specific population incidence. The incidence of ischaemic colitis in general populations ranged from 4.5 to 44 cases per 100 000 person-years. The risk was increased two- to four-fold by either prevalent irritable bowel syndrome or chronic obstructive pulmonary disease. The risk was also increased in females and in subjects of 65 years and older. CONCLUSIONS: Ischaemic colitis is uncommon in the general population. The effect sizes of the most commonly reported risk factors have not been adequately quantified in population-based studies.

Adult↗
PubMed2006

Which drugs cause preventable admissions to hospital? A systematic review.

AIMS: Previous systematic reviews have found that drug-related morbidity accounts for 4.3% of preventable hospital admissions. None, however, has identified the drugs most commonly responsible for preventable hospital admissions. The aims of this study were to estimate the percentage of preventable drug-related hospital admissions, the most common drug causes of preventable hospital admissions and the most common underlying causes of preventable drug-related admissions. METHODS: Bibliographic databases and reference lists from eligible articles and study authors were the sources for data. Seventeen prospective observational studies reporting the proportion of preventable drug-related hospital admissions, causative drugs and/or the underlying causes of hospital admissions were selected. Included studies used multiple reviewers and/or explicit criteria to assess causality and preventability of hospital admissions. Two investigators abstracted data from all included studies using a purpose-made data extraction form. RESULTS: From 13 papers the median percentage of preventable drug-related admissions to hospital was 3.7% (range 1.4-15.4). From nine papers the majority (51%) of preventable drug-related admissions involved either antiplatelets (16%), diuretics (16%), nonsteroidal anti-inflammatory drugs (11%) or anticoagulants (8%). From five studies the median proportion of preventable drug-related admissions associated with prescribing problems was 30.6% (range 11.1-41.8), with adherence problems 33.3% (range 20.9-41.7) and with monitoring problems 22.2% (range 0-31.3). CONCLUSIONS: Four groups of drugs account for more than 50% of the drug groups associated with preventable drug-related hospital admissions. Concentrating interventions on these drug groups could reduce appreciably the number of preventable drug-related admissions to hospital from primary care.

Adolescent↗
PubMed2006

Assessing the relationships between contextual factors and research utilization in nursing: systematic literature review.

AIM: This paper reports a systematic literature review examining relationships between contextual factors and research utilization in nursing, examining the strength of these relationships, and mapping the contextual factors to the Promoting Action on Research Implementation in Health Services model of research implementation. BACKGROUND: Healthcare organizations have long struggled with how to improve clinical care outcomes. Understanding which contextual factors enhance nursing research utilization may support organizations in creating environments that facilitate the uptake of evidence in nursing practice to improve these outcomes. METHODS: A search of five electronic bibliographic databases and a manual search of specific journals were conducted for studies that were published in English and examined contextual factors as independent variables and research utilization as the dependent variable from the perspective of nurses working in clinical practice. The studies were assessed for quality of design, sample, measurement and statistical analysis. RESULTS: Ten papers met the search criteria. Six contextual factors were identified as having a statistically significant relationship with research utilization, namely the role of the nurse, multi-faceted access to resources, organizational climate, multi-faceted support, time for research activities and provision of education. The contextual factors could successfully be mapped to the dimensions of context in the Promoting Action on Research Implementation in Health Services framework (context, culture, leadership), with the exception of evaluation. CONCLUSION: The strength of the relationship between the six contextual factors and research utilization by nurses is still largely unknown as (a) few studies were found of sufficient quality because of methodological limitations and (b) the results in reviewed studies were mixed. More robust methods in future work would yield a better understanding of the full impact of contextual factors on nurses' use of research.

Attitude of Health Personnel↗
PubMed2004

Attitudes and knowledge of primary care professionals towards evidence-based practice: a postal survey.

OBJECTIVES: To describe the attitudes, awareness and use of evidence across key professional groups working in primary care. METHODS: A postal questionnaire was sent to all lead/chairs, general managers, clinical governance leads, lead nurses, lead pharmacists and public health practitioners working in local health care cooperatives in Scotland. RESULTS: 289 (66.1%) health care professionals responded, ranging from 51% of general managers to 80% of lead nurses. All professional groups supported evidence-based practice. General practitioners (GPs) were less likely to agree that they had the skills to carry out literature reviews or appraise evidence compared to nurses and public health facilitators (36% vs. 75% vs. 80%; 51% vs. 64% vs. 70%). Access to the internet and bibliographic databases was good for all groups but GPs used a narrower spectrum of evidence-based journals, relying mainly on medical literature. Only nurses and public health practitioners appeared to have any understanding of qualitative research terms. Public health practitioners were also least likely to view guidelines or protocols developed by others as the best source of evidence for primary care. The major perceived barrier to practising evidence-based practice was time. Consequently the most important facilitator was protected time, but increased resources (financial and staff) and training were also cited. Professional groups other than GPs perceived inter-professional boundaries as a barrier and suggested multi-professional teamworking and learning as potential supports for evidence-based practice. CONCLUSIONS: While all professional groups welcome and support evidence-based practice, there are clear differences in the starting point and perspectives across the groups. These need to recognized and addressed to ensure that learning the skills of evidence-based practice and implementing evidence are effective. This will also enhance the ability of primary care organizations to develop robust mechanisms for supporting key aspects of clinical governance.

Attitude of Health Personnel↗
PubMed2004

The effect of metformin on blood pressure, plasma cholesterol and triglycerides in type 2 diabetes mellitus: a systematic review.

BACKGROUND: The UKPDS 34 showed that intensive treatment with metformin significantly reduces macrovascular end-points and mortality in individuals with newly diagnosed type 2 diabetes compared with intensive treatment with insulin or sulphonylurea derivatives, despite similar glycaemic control. How this should be explained is as yet unclear. We hypothesized that metformin may have a glucose-lowering independent effect on blood pressure and lipid profile. In order to test this hypothesis we systematically reviewed the literature and pooled the data obtained in a meta-analysis. METHODS: Included were randomized-controlled trials in patients with type 2 diabetes mellitus and metformin treatment lasting at least 6 weeks. To identify all eligible trials we conducted electronic searches using the bibliographic databases Medline and Embase, contacted the manufacturer and checked obtained publications for cross-references. RESULTS: Forty-one studies (3074 patients) provided data on blood pressure and/or lipid profile. When compared with control treatment, metformin associated effects on systolic and diastolic blood pressure and HDL cholesterol were small and statistically not significant [-1.09 mmHg 95% confidence interval (-3.01-0.82), P = 0.30; -0.97 (-2.15-0.21) mmHg, P = 0.11 and +0.01 (-0.02-0.03) mmol L(-1), P = 0.50, respectively]. Compared with control treatment, however, metformin decreased plasma triglycerides, total cholesterol and LDL cholesterol significantly [-0.13 (-0.21--0.04) mmol L(-1), P = 0.003; -0.26 (-0.34--0.18) mmol L(-1), P < 0.0001 and -0.22 (-0.31--0.13) mmol L(-1), P < 0.00001, respectively]. We found no indications for publication bias. Of note, glycaemic control as assessed by HbA1c was better with metformin than with control treatment [-0.74 (-0.84--0.65) percentage point; P < 0.00001]. When studies were subdivided into tertiles according to increasing difference in glycaemic control between metformin and control treatment, it appeared that in case of near similar glycaemic control metformin had no effect versus control treatment on triglycerides, whereas still there was a significant effect on total and LDL cholesterol. CONCLUSIONS: This meta-analysis of randomized-controlled clinical trials suggests that metformin has no intrinsic effect on blood pressure, HDL cholesterol and triglycerides in patients with type 2 diabetes. This drug, however, independent of its effect on glycaemia, reduces total and LDL cholesterol significantly, but the reductions in these variables are relatively small.

Blood Pressure↗
PubMed1994

Computer education: attitudes and opinions of first-year medical students.

Students' attitudes toward medical informatics were evaluated with self-administered questionnaires, answered by 140 (77%) first-year medical and dental students. Fourteen per cent classified their computer literacy as negligible and 49% as deficient. Ninety-six per cent had used a computer before and 59% used one regularly. Nineteen per cent had computer education in secondary school and a further 16% attended courses given by a computer company. Only 16% read regularly about informatics. These results are similar to those observed in more industrialized countries, except that high-school education is more deficient. To 93% of these students, computer literacy is important for doctors, and to 85% computers may be very useful in many areas of health care. In the opinion of 66% of students, the computer-based patient record will be available within the next 3 to 10 years. Women showed lesser computer literacy (77% computer illiteracy to 39% in men), but there were no relevant differences in attitudes, behaviour and beliefs towards medical informatics between gender, for the same level of computer literacy. Computer education in the undergraduate curriculum was demanded by 92%, and 75% of these preferred an elective course. Weekly hours suggested for lectures should be 1 (54%) or 2 (42%), and for hands-on practice 2 (54%) or 4 (31%) hours. The curriculum should include medical applications (83% of students), information science theory and technology (44%), micro-informatics (44%), bibliographic database search (27%), programming languages (23%) and statistical packages (23%). Gender, computer literacy or course did not correlate significantly with students' opinions about the contents of undergraduate education.

Attitude of Health Personnel↗
PubMed2006

Forgoing life sustaining treatments: differences and similarities between North America and Europe.

BACKGROUND: As evidence exist that severe neurological damage or prolonged death after inappropriate CPR could occur, restraints and indications for CPR were perceived as necessary. The objective of this review is to examine policies and attitudes towards end-of-life decisions in Europe and North America and to outline differences and similarities. METHODS: A bibliographic database search from 1990 to 2006 was performed using the following terms: do-not-resuscitate orders, end-of-life decisions, withholding/withdrawal of life-sustaining treatments, medical futility and advanced directives. Eighty-eight articles, out of 305 examined, were analyzed and their data systematically reported and compared where possible. They consisted of studies, questionnaires and surveys answering the following questions: percentage of deaths of critical patients preceded by do-not-resuscitate orders, factors affecting the decision for do-not-resuscitate orders, people involved in this decision (patient, surrogates and medical staff) and how it was performed. RESULTS: There is an evident gap between the North American use of standard and formal procedures compared with Europe. Second, they diverge in the role acknowledged to surrogates in the decisional process, as in Europe, restraints and reserves to accept surrogates as decision makers seem still strong and a paternalistic approach at the end-of-life is still present. CONCLUSION: Incidentally, despite the predictable differences between Europe and North America, concerns do exist about the actual extent of autonomy wished by patients and surrogates. It is important to highlight these findings, as the paternalistic attitude, too often negatively depicted, could be, according to the best medical practice, justified and more welcomed in some instances.

Cardiopulmonary Resuscitation↗
PubMed2005

The effectiveness of family interventions in people with diabetes mellitus: a systematic review.

AIMS: To conduct a systematic review of reports of published literature to assess which family interventions are effective in improving diabetes-related outcomes in people with diabetes and family members (blood or non-blood relatives) residing in their homes. METHODS: We searched computerized bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, WOS, ERIC, Cochrane, CDP, and SocAbs) for randomized clinical trials published in any language that evaluated the effectiveness of family-based interventions with no age restriction. Only studies focused on interventions in young populations (< 18 years) and involving a parent were combined in a meta-analysis for glycated haemoglobin (GHb) using DerSimonian and Laird random effects model. Effect sizes for knowledge outcomes were estimated using the Cohen's d (standardized mean differences) formula. RESULTS: Our searches identified 19 randomized controlled trials. Positive effect sizes of family interventions on knowledge for five studies (N = 217) were demonstrated {0.94 [95% confidence interval (CI) 0.67, 1.82]}. A beneficial effect of interventions on GHb for eight studies (N = 505) was also observed using meta-analysis [-0.6 (95% CI -1.2, -0.1)]. CONCLUSIONS: Evidence suggests that family interventions in family or household members of people with diabetes may be effective in improving diabetes-related knowledge and glycaemic control.

Adult↗