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PubMed1993

Specificity of ICD-9-CM coding practices for stroke rehabilitation.

Designed for acute care classification, the 9th version of the International Classification of Disease, Clinical Modification (ICD-9-CM) is also used to describe the principal diagnosis in medical rehabilitation. ICD-9-CM (ICD-9) coding practices for all stroke cases found in two nationally representative databases were examined (sample sizes over 17,000 and over 2,000). Of the more than 100 codes selected, four were indicated for 67% and 72% of stroke cases in the two data sets, respectively. Codes 436 and 438 distinguish acute from late stroke effects; whereas code 434.9 identifies stroke, but not its duration. The most frequently used code in the larger database, 342.9, refers to the manifestation of hemiplegia rather than to diagnosis, and thus is not specific to stroke. Other less frequently selected ICD-9 codes are more specific to the underlying pathophysiology (e.g., thrombosis, embolus or hemorrhage). Results emphasize the need for more precise selection of etiologic ICD-9 codes for stroke rehabilitation so that they describe specific pathology.

Cerebrovascular Disorders↗
PubMed2005

YPL.db2: the Yeast Protein Localization database, version 2.0.

The Yeast Protein Localization database (YPL.db(2)) is an archive of microscopic image data of protein localization patterns in the yeast Saccharomyces cerevisiae. The current version of YPL.db(2) harbours 500 sets of image data derived from high-resolution microscopic analyses of proteins tagged with the green fluorescent protein (GFP). Major functional improvements in YPL.db(2) over a previous release are a web-based experiment and image submission interface, facilitating standardized data entry by remote users through the Internet. The image display page provides image gallery and image scrolling features. In addition, fluorescence and transmission images can be superimposed, allowing image fading for precise correlation of the protein's localization in the cellular context. The reference structure database displaying 'prototypic' localization patterns was extended, and a feature to display and manipulate 3D-image datasets, using a freely available VRML plug-in, was included. Access to the Yeast Protein Localization database version 2.0 (YPL.db(2)) is available through http://YPL.uni-graz.at.

Databases, Protein↗
PubMed2001

Electronic documentation in endoscopy: present status and future perspectives from a company standpoint.

At the beginning of the development of endoscopic information systems all companies were technology-oriented. Today, we see a change from technology to content orientation, the same development which is seen in internet technology. In future systems, it will not be the software that makes a difference but the contents. Contents means not only patient data but also algorithms for feature extraction within large databases with reference images, for example [20]. The automatic recognition of features, such as a complication rate that is too high or a correlation of a certain disease with an endoscopic finding, will be part of a content-based approach. It means that content will also be the knowledge base which has to be developed for future systems. The system of the future will be much more intelligent and less software technology-oriented.

Computer Communication Networks↗
PubMed2005

Functional insights from the distribution and role of homopeptide repeat-containing proteins.

Expansion of "low complex" repeats of amino acids such as glutamine (Poly-Q) is associated with protein misfolding and the development of degenerative diseases such as Huntington's disease. The mechanism by which such regions promote misfolding remains controversial, the function of many repeat-containing proteins (RCPs) remains obscure, and the role (if any) of repeat regions remains to be determined. Here, a Web-accessible database of RCPs is presented. The distribution and evolution of RCPs that contain homopeptide repeats tracts are considered, and the existence of functional patterns investigated. Generally, it is found that while polyamino acid repeats are extremely rare in prokaryotes, several eukaryote putative homologs of prokaryote RCP-involved in important housekeeping processes-retain the repetitive region, suggesting an ancient origin for certain repeats. Within eukarya, the most common uninterrupted amino acid repeats are glutamine, asparagines, and alanine. Interestingly, while poly-Q repeats are found in vertebrates and nonvertebrates, poly-N repeats are only common in more primitive nonvertebrate organisms, such as insects and nematodes. We have assigned function to eukaryote RCPs using Online Mendelian Inheritance in Man (OMIM), the Human Reference Protein Database (HRPD), FlyBase, and Wormpep. Prokaryote RCPs were annotated using BLASTp searches and Gene Ontology. These data reveal that the majority of RCPs are involved in processes that require the assembly of large, multiprotein complexes, such as transcription and signaling.

Amino Acid Sequence↗
PubMedDate not supplied

Chronomes, time structures, for chronobioengineering for "a full life".

Week-long or longer monitoring of blood pressure and heart rate, coupled to time-structure analyses, can help detect disease-risk elevations, as a warning of the need for a preventive prehabilitation. Within the normal range of physiologic variation, computer methods quantify time structures, or chronomes, that can serve as reference values. The major applied purpose for mapping chronomes is the detection of disease-risk syndromes such as blood pressure "overswinging" and heart rate "underswinging." Too much blood pressure variability (circadian hyperamplitude tension; CHAT), is a risk factor for vascular disease. Other risk syndromes are chronome alterations of heart rate variability (CAHRVs), consisting of a loss of "jitter", i.e., a reduced standard deviation of heart rate or of alterations in the spectral element of the heart-rate-variability chronome, such as in the correlation dimension, an endpoint of deterministic chaos. These alterations can again serve for prehabilitation. On the basic side, the spectral element of the heart-rate-variability chronomes extends from focus on the heartbeat's period of about 1 second to periods in heart rate and its standard deviation that are numerical equivalents of about 10.5- and about 21-year cycles of solar activity. A seemingly unnatural physiologic rhythm or pattern (such as one of 81.6 hours) may correspond numerically to a purely physical environmental rhythm. For example, interplanetary magnetic storms, with their cycles as external chronome components, trigger myocardial infarctions, strokes, and traffic accidents. The systematic monitoring of external rhythms along with physiologic ones for the concurrent analysis of rhythms with longer and longer periods could detect alterations anywhere in and between the 1 cycle/sec and the 1 cycle/10.5- or 21-years regions of the spectrum. Chronobiomimetic engineering for discovering both instantaneous and long-term chronorisk alterations can provide warnings of increased risk. If risk-lowering therapy is then instituted automatically, instrumented health care will be extended beyond the pacemaker-cardioverter-defibrillator, which focuses on the frequency of 1 cycle/sec. Instrumentation that automatically detects blood pressure that varies too much and heart rate that varies too little is needed for prompting prophylactic CHAT and CAHRV treatment. A database of reference values that can be used for chronodiagnosis is now accumulating.

Accidents, Traffic↗
PubMed2004

The influence of gapped positions in multiple sequence alignments on secondary structure prediction methods.

All currently leading protein secondary structure prediction methods use a multiple protein sequence alignment to predict the secondary structure of the top sequence. In most of these methods, prior to prediction, alignment positions showing a gap in the top sequence are deleted, consequently leading to shrinking of the alignment and loss of position-specific information. In this paper we investigate the effect of this removal of information on secondary structure prediction accuracy. To this end, we have designed SymSSP, an algorithm that post-processes the predicted secondary structure of all sequences in a multiple sequence alignment by (i) making use of the alignment's evolutionary information and (ii) re-introducing most of the information that would otherwise be lost. The post-processed information is then given to a new dynamic programming routine that produces an optimally segmented consensus secondary structure for each of the multiple alignment sequences. We have tested our method on the state-of-the-art secondary structure prediction methods PHD, PROFsec, SSPro2 and JNET using the HOMSTRAD database of reference alignments. Our consensus-deriving dynamic programming strategy is consistently better at improving the segmentation quality of the predictions compared to the commonly used majority voting technique. In addition, we have applied several weighting schemes from the literature to our novel consensus-deriving dynamic programming routine. Finally, we have investigated the level of noise introduced by prediction errors into the consensus and show that predictions of edges of helices and strands are half the time wrong for all the four tested prediction methods.

Algorithms↗
PubMed2006

Probabilistic approach to determining unbiased random-coil carbon-13 chemical shift values from the protein chemical shift database.

We describe a probabilistic model for deriving, from the database of assigned chemical shifts, a set of random coil chemical shift values that are "unbiased" insofar as contributions from detectable secondary structure have been minimized (RCCSu). We have used this approach to derive a set of RCCSu values for 13Calpha and 13Cbeta for 17 of the 20 standard amino acid residue types by taking advantage of the known opposite conformational dependence of these parameters. We present a second probabilistic approach that utilizes the maximum entropy principle to analyze the database of 13Calpha and 13Cbeta chemical shifts considered separately; this approach yielded a second set of random coil chemical shifts (RCCSmax-ent). Both new approaches analyze the chemical shift database without reference to known structure. Prior approaches have used either the chemical shifts of small peptides assumed to model the random coil state (RCCSpeptide) or statistical analysis of chemical shifts associated with structure not in helical or strand conformation (RCCSstruct-stat). We show that the RCCSmax-ent values are strikingly similar to published RCCSpeptide and RCCSstruct-stat values. By contrast, the RCCSu values differ significantly from both published types of random coil chemical shift values. The differences (RCCSpeptide - RCCSu) for individual residue types show a correlation with known intrinsic conformational propensities. These results suggest that random coil chemical shift values from both prior approaches are biased by conformational preferences. RCCSu values appear to be consistent with the current concept of the "random coil" as the state in which the geometry of the polypeptide ensemble samples the allowed region of (phi, psi)-space in the absence of any dominant stabilizing interactions and thus represent an improved basis for the detection of secondary structure. Coupled with the growing database of chemical shifts, this probabilistic approach makes it possible to refine relationships among chemical shifts, their conformational propensities, and their dependence on pH, temperature, or neighboring residue type.

Carbon Isotopes↗
PubMed2001

Toxicant- and response-specific comparisons of statistical methods for estimating effective concentrations.

Standard U.S. Environmental Protection Agency (U.S. EPA) statistical analyses of whole effluent toxicity tests involve the estimation of the concentration associated with a specified level of inhibition relative to control responses. Current U.S. EPA estimation methods (linear interpolation or probit-based methods) are compared to a recently developed parametric regression-based estimator, the relative inhibition concentration estimator RIp. The RIp estimation technique, with level of inhibition p = 25%, is applied to a series of chronic toxicity test data from a U.S. EPA Region 9 database of reference toxicity tests. Tests on marine species are conducted with one reference toxicant, while the freshwater tests are conducted with several reference toxicants. While the U.S. EPA estimators and the RIp estimator are highly correlated for red abalone larval shell development, the degree of correlation for fathead minnow responses varies with reference toxicant tested. The strength of the relationship between the RIp and the standard U.S. EPA estimators varies as a function of the reference toxicant. Correlations range between 0.67 and 0.99. For all biological responses included in this evaluation (fathead minnow growth or survival and red abalone larval development), experiments occurred where the RIp is estimable, while the standard U.S. EPA estimators are not. Nonestimability of the standard EPA methods appears to be related, in part, to the failure of models to account for enhanced responses, such as a hormesis effect prior to toxicity being manifest. The ability to account for such enhanced responses is a strength of the RIp method. Finally, a variance component analysis suggests that lab-to-lab variability is relatively low for the red abalone but relatively high for the fathead minnow.

Animals↗
PubMed2004

Bone mineral density during maintenance treatment with supraphysiological doses of levothyroxine in affective disorders: a longitudinal study.

BACKGROUND: This prospective study was designed to determine whether patients with prophylaxis-resistant affective disorders, receiving adjunctive maintenance therapy with supraphysiological doses of levothyroxine (L-T4), show evidence of accelerated bone loss compared to the reference population database. METHODS: In 21 patients, bone mineral density (BMD) of the spine (lumbar vertebrae L1-L4) and femur (femoral neck, trochanter, and Ward's triangle) was measured by dual energy X-ray absorptiometry (DXA). BMD measurement was performed first after patients had been on thyroid-stimulating hormone (TSH)-suppressive therapy with L-T4 (mean dose=411 mcg/d) for an average of 16.4 months and again after 33.6 months of L-T4 (mean dose=416 mcg/d) therapy. RESULTS: There was no statistically significant difference between the actual percentage decline in bone mineral density and the expected percentage decline in any of the measured bone regions. In a stepwise linear regression analysis, age was identified as a predictor of percentage change in BMD. After controlling for age, the only other variable that showed a consistent trend was the dose of L-T4, with higher doses being positively correlated with the percentage decline of BMD. LIMITATIONS: Relatively small sample size, no bone density assessment prior to treatment with L-T4, no patient control group with mood disorders who did not receive L-T4 treatment, and bone density follow-up intervals were variable. CONCLUSIONS: This study did not demonstrate evidence that long-term treatment of affectively ill patients with supraphysiological doses of L-T4 significantly accelerates loss of bone mineral density compared to the age-matched reference population. However, the decline of BMD in one individual patient underscores that caution is indicated and that regular assessment of BMD during longer-term supraphysiological thyroid hormone treatment is needed.

Absorptiometry, Photon↗
PubMed1998

Treatment of Adamantiades-Behçet disease with systemic interferon alfa.

OBJECTIVE: To evaluate the efficacy and safety of systemic interferon alfa treatment in patients with Adamantiades-Behçet disease. DATA SOURCES: Reports and abstracts published in 1986 through 1997 in all languages were identified by the MEDLINE database, the Reference Index Related to Behcet's Disease, the Behçet disease conference proceedings, and abstract booklets. The indexing terms used Behçet and interferon. STUDY SELECTION: Twenty-two reports identified were included to estimate the efficacy of interferon alfa on mucocutaneous, ocular, and joint manifestations. Responses of individual mucocutaneous signs were evaluated in 8 reports. Adverse effects were sufficiently documented in 12 reports. All patients met the criteria of the Behçet Syndrome Research Committee of Japan or those of the International Study Group for Behçet's Disease. DATA EXTRACTION: Data were extracted and evaluated according to the following criteria: complete remission, disappearance of all manifestations during treatment; partial remission, greater than 50% decrease in the number, severity, duration and/or frequency of recurrence of the lesions; stable disease, less than 50% change in the manifestations; and progressive disease, greater than 50% deterioration of existing manifestations or/and the development of new ones. DATA SYNTHESIS: Systemic interferon alfa has been administered in 144 patients with Adamantiades-Behçet disease by subcutaneous or intramuscular injections of 3 to 18 x 10(6) units of interferon alfa-2a (70 patients) or 3 to 5 x 10(6) units of interferon alfa-2b (74 patients) daily or 3 times per week for 1 to 60 months. Seventy-four percent (92/124) of patients with mucocutaneous manifestations, 95% (37/39) of patients with uveitis, and 93% (51/55) of patients with arthropathy/arthritis exhibited a partial or complete response. Interferon alfa-2a regimens were more effective than interferon alfa-2b ones on mucocutaneous (47% vs 7% complete response) and ocular (67% vs 8% complete response; P < .001) manifestations. Mucocutaneous and ocular manifestations responded within 1 to 4 months after initiation of therapy. Thirty-eight percent (20/52) of patients with mucocutaneous lesions, 73% (8/11) of patients with uveitis, and 88% (21/24) of patients with arthropathy/arthritis experienced recurrences immediately or up to 7 months after discontinuation of treatment. Mild adverse effects were generally recorded; transient influenza-like symptoms (87% vs 63%; P < .05) and reversible leukopenia (24% vs 4%; P < .05) occurred more often under interferon alfa-2a regimens, while reversible mild alopecia was more common in patients receiving interferon alfa-2b (2% vs 28%; P < .01). CONCLUSIONS: Systemic interferon alfa treatment is reasonable for Adamantiades-Behçet disease. A 3-month high-dose regimen (9 x 10(6) units 3 times per week) followed by a low maintenance dose (3 x 10(6) units 3 times per week) is recommended.

Adolescent↗
PubMed2002

The effect of antidepressant treatment on chronic back pain: a meta-analysis.

BACKGROUND: Back pain is one of the most common problems in primary care. Antidepressant medication is often prescribed, especially for chronic back discomfort, to alleviate pain and restore the patient's ability to conduct activities of daily living. OBJECTIVE: To assess the efficacy of antidepressants in treating back pain in adults. METHODS: We searched the MEDLINE (1966-2000), PsycLit, Cinhal, EMBASE, AIDSLINE, HealthSTAR, CANCERLIT, the Cochrane Library (clinical trials registry and the Database of Systematic Reviews), Micromedex, and Federal Research in Progress databases and references of reviewed articles. Included articles were written in English and dealt with randomized placebo-controlled trials of antidepressant medication use among adults with chronic back pain. Two reviewers abstracted data independently. Two continuous outcomes, change in back pain severity and ability to perform activities of daily living, were measured. Study quality was assessed with the methods used by Jadad and colleagues, and data were synthesized using a random-effects model. RESULTS: Nine randomized controlled trials with 10 treatment arms and 504 patients were included. Seven treatment arms included patients with major depression. Patients had chronic back pain, averaging 10.4 years. Patients treated with antidepressants were more likely to improve in pain severity than those taking placebo (standardized mean difference, 0.41; 95% confidence interval, 0.22-0.61) but not in activities of daily living (standardized mean difference, 0.24; 95% confidence interval, -0.21-0.69). Patients treated with antidepressants experienced more adverse effects (22% vs 14%, P =.01) than those receiving placebo. CONCLUSION: Antidepressants are more effective than placebo in reducing pain severity but not functional status in chronic back pain.

Activities of Daily Living↗
PubMed2002

Postmenopausal hormone replacement therapy: scientific review.

CONTEXT: Although postmenopausal hormone replacement therapy (HRT) is widely used in the United States, new evidence about its benefits and harms requires reconsideration of its use for the primary prevention of chronic conditions. OBJECTIVE: To assess the benefits and harms of HRT for the primary prevention of cardiovascular disease, thromboembolism, osteoporosis, cancer, dementia, and cholecystitis by reviewing the literature, conducting meta-analyses, and calculating outcome rates. DATA SOURCES: All relevant English-language studies were identified in MEDLINE (1966-2001), HealthSTAR (1975-2001), Cochrane Library databases, and reference lists of key articles. Recent results of the Women's Health Initiative (WHI) and the Heart and Estrogen/progestin Replacement Study (HERS) are included for reported outcomes. STUDY SELECTION AND DATA EXTRACTION: We used all published studies of HRT if they contained a comparison group of HRT nonusers and reported data relating to HRT use and clinical outcomes of interest. Studies were excluded if the population was selected according to prior events or presence of conditions associated with higher risks for targeted outcomes. DATA SYNTHESIS: Meta-analyses of observational studies indicated summary relative risks (RRs) for coronary heart disease (CHD) incidence and mortality that were significantly reduced among current HRT users only, although risk for incidence was not reduced when only studies that controlled for socioeconomic status were included. The WHI reported increased CHD events (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.02-1.63). Stroke incidence but not mortality was significantly increased among HRT users in the meta-analysis and the WHI. The meta-analysis indicated that risk was significantly elevated for thromboembolic stroke (RR, 1.20; 95% CI, 1.01-1.40) but not subarachnoid or intracerebral stroke. Risk of venous thromboembolism among current HRT users was increased overall (RR, 2.14; 95% CI, 1.64-2.81) and was highest during the first year of use (RR, 3.49; 95% CI, 2.33-5.59) according to a meta-analysis of 12 studies. Protection against osteoporotic fractures is supported by a meta-analysis of 22 estrogen trials, cohort studies, results of the WHI, and trials with bone density outcomes. Current estrogen users have an increased risk of breast cancer that increases with duration of use. Endometrial cancer incidence, but not mortality, is increased with unopposed estrogen use but not with estrogen with progestin. A meta-analysis of 18 observational studies showed a 20% reduction in colon cancer incidence among women who had ever used HRT (RR, 0.80; 95% CI, 0.74-0.86), a finding supported by the WHI. Women symptomatic from menopause had improvement in certain aspects of cognition. Current studies of estrogen and dementia are not definitive. In a cohort study, current HRT users had an age-adjusted RR for cholecystitis of 1.8 (95% CI, 1.6-2.0), increasing to 2.5 (95% CI, 2.0-2.9) after 5 years of use. CONCLUSIONS: Benefits of HRT include prevention of osteoporotic fractures and colorectal cancer, while prevention of dementia is uncertain. Harms include CHD, stroke, thromboembolic events, breast cancer with 5 or more years of use, and cholecystitis.

Breast Neoplasms↗
PubMed2005

The clinical sequelae of intravascular hemolysis and extracellular plasma hemoglobin: a novel mechanism of human disease.

CONTEXT: The efficient sequestration of hemoglobin by the red blood cell membrane and the presence of multiple hemoglobin clearance mechanisms suggest a critical need to prevent the buildup of this molecule in the plasma. A growing list of clinical manifestations attributed to hemoglobin release in a variety of acquired and iatrogenic hemolytic disorders suggests that hemolysis and hemoglobinemia should be considered as a novel mechanism of human disease. EVIDENCE ACQUISITION: Pertinent scientific literature databases and references were searched through October 2004 using terms that encompassed various aspects of hemolysis, hemoglobin preparations, clinical symptoms associated with plasma hemoglobin, nitric oxide in hemolysis, anemia, pulmonary hypertension, paroxysmal nocturnal hemoglobinuria, and sickle-cell disease. EVIDENCE SYNTHESIS: Hemoglobin is released into the plasma from the erythrocyte during intravascular hemolysis in hereditary, acquired, and iatrogenic hemolytic conditions. When the capacity of protective hemoglobin-scavenging mechanisms has been saturated, levels of cell-free hemoglobin increase in the plasma, resulting in the consumption of nitric oxide and clinical sequelae. Nitric oxide plays a major role in vascular homeostasis and has been shown to be a critical regulator of basal and stress-mediated smooth muscle relaxation and vasomotor tone, endothelial adhesion molecule expression, and platelet activation and aggregation. Thus, clinical consequences of excessive cell-free plasma hemoglobin levels during intravascular hemolysis or the administration of hemoglobin preparations include dystonias involving the gastrointestinal, cardiovascular, pulmonary, and urogenital systems, as well as clotting disorders. Many of the clinical sequelae of intravascular hemolysis in a prototypic hemolytic disease, paroxysmal nocturnal hemoglobinuria, are readily explained by hemoglobin-mediated nitric oxide scavenging. CONCLUSION: A growing body of evidence supports the existence of a novel mechanism of human disease, namely, hemolysis-associated smooth muscle dystonia, vasculopathy, and endothelial dysfunction.

Disease↗
PubMed2000

Homeopathy for chronic asthma.

BACKGROUND: Homeopathy involves the use, in dilution, of substances which cause symptoms in their undiluted form. It is one of the most widespread forms of complementary medicines and is also used to treat asthma. OBJECTIVES: The objective of this review was to assess the effects of homeopathy in people with chronic stable asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register, the Cochrane Complementary Medicine Field trials register, the Glasgow Homeopathic Hospital database, the Muenchener Modell database and reference lists of articles. SELECTION CRITERIA: Randomised and possibly randomised trials of homeopathy for the treatment of stable chronic asthma, with observation periods of at least one week. DATA COLLECTION AND ANALYSIS: Data extraction was done by one reviewer and checked by the second reviewer. Trial quality was assessed by the reviewers. MAIN RESULTS: Three trials with a total of 154 people were included. These trials were all placebo-controlled and double-blind, but of variable quality. They used three different homeopathic treatments which precluded quantitative pooling of results. The standardised treatments in these trials are unlikely to represent common homeopathic practice, where treatment tends to be individualised. In one trial, severity of symptoms was lessened in the homeopathy group compared to the placebo group. In another trial, lung function measures and medication use showed improvement in the homeopathy group compared to the placebo group. The third trial found improvement in both the homeopathy and placebo groups, but no difference between the groups. REVIEWER'S CONCLUSIONS: There is not enough evidence to reliably assess the possible role of homeopathy in asthma. As well as randomised trials, there is a need for observational data to document the different methods of homeopathic prescribing and how patients respond.

Asthma↗
PubMed2004

Homeopathy for chronic asthma.

BACKGROUND: Homeopathy involves the use, in dilution, of substances which cause symptoms in their undiluted form. It is one of the most widespread forms of complementary medicines and is also used to treat asthma. OBJECTIVES: The objective of this review was to assess the effects of homeopathy in people with chronic stable asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register, the Cochrane Complementary Medicine Field trials register, the Glasgow Homeopathic Hospital database, the Münchener Modell database and reference lists of articles. Searches were current as of August 2003. SELECTION CRITERIA: Randomised trials of homeopathy for the treatment of stable chronic asthma, with observation periods of at least one week were included. DATA COLLECTION AND ANALYSIS: Data extraction was undertaken by two reviewers. Trial quality was assessed by the reviewers. MAIN RESULTS: Six trials with a total of 556 people were included. These trials were all placebo-controlled and double-blind, but of variable quality. They used different homeopathic treatments which precluded quantitative pooling of results for the primary outcome. Standardised treatments in these trials are unlikely to represent common homeopathic practice, where treatment tends to be individualised. No trial reported a significant difference on validated symptom scales. There were conflicting results in terms of lung function between the studies. There has been only a limited attempt to measure a 'package of care' effect (i.e., the effect of the medication as well as the consultation, which is considered a vital part of individualised homeopathic practice). REVIEWER'S CONCLUSIONS: There is not enough evidence to reliably assess the possible role of homeopathy in asthma. As well as randomised trials, there is a need for observational data to document the different methods of homeopathic prescribing and how patients respond. This will help to establish to what extent people respond to a 'package of care' rather than the homeopathic intervention alone.

Asthma↗
PubMed2000

Pool fencing for preventing drowning in children.

BACKGROUND: In most industrialized countries, drowning ranks second or third behind motor vehicles and fires as a cause of unintentional injury deaths to children under the age of 15. Death rates from drowning are highest in children less than five years old. Pool fencing is a passive environmental intervention designed to reduce unintended access to swimming pools and thus prevent drowning in the preschool age group. Because of the magnitude of the problem and the potential effectiveness of fencing we decided to evaluate the effect of pool fencing as a drowning prevention strategy for young children. OBJECTIVES: To determine if pool fencing prevents drowning in young children. SEARCH STRATEGY: We used Cochrane Collaboration search strategy of electronic databases, searched reference lists of past reviews and review articles, Cochrane International Register of RCT's, studies from government agencies in the United States and Australia, and contacted colleagues from International Society for Child and Adolescent Injury Prevention, World Injury Network, and CDC funded Injury Control and Research Centers. SELECTION CRITERIA: In order to be selected a study had to be designed to evaluate pool fencing in a defined population and provide relevant and interpretable data which objectively measured the risk of drowning or near drowning or provided rates of these outcomes in fenced and unfenced pools. The completed studies meeting selection criteria employed a case-control design. No randomized controlled studies have been identified. DATA COLLECTION AND ANALYSIS: Three published studies met selection criteria. Data were extracted by two reviewers using standard abstract form. Odds ratios with 95% CI, and incidence rates, were calculated for drowning and near-drowning. Attributable Risk percent (AR%) was calculated to report the reduction in drowning due to pool fencing. MAIN RESULTS: Case control studies which evaluate pool fencing interventions indicate that pool fencing significantly reduces the risk of drowning. Odds ratio for the risk of drowning or near drowning in a fenced pool compared to an unfenced pool is 0.27 95%CI (0.16, 0.47). Isolation fencing (enclosing pool only) is superior to perimeter fencing (enclosing property and pool) because perimeter fencing allows access to the pool area through the house. Odds ratio for the risk of drowning in a pool with isolation fencing compared to a pool with three sided fencing is 0.17 95%CI (0.07, 0.44) REVIEWER'S CONCLUSIONS: Pool fences should have a dynamic and secure gate and isolate (i.e., four-sided fencing) the pool from the house. Legislation should require isolation fencing with secure, self-latching gates for all pools, public, semi-public and private.

Accident Prevention↗
PubMed2000

Support for breastfeeding mothers.

BACKGROUND: Exclusive breastfeeding rates at three to four months remain low in many health care settings. In economically advantaged countries, young mothers, those in low-income groups or those who ceased full-time education at an early age are least likely to breastfeed. In poorer countries, more affluent groups may breastfeed less. OBJECTIVES: The objective of this review was to assess the effects of breastfeeding support. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register (last searched March 1998), Medline (from 1993), Embase (from 1980), Cinahl, Midirs (from 1991), English National Health Board database and reference lists of articles. We contacted researchers in the field. SELECTION CRITERIA: Controlled trials of acceptable quality comparing extra support for breastfeeding mothers with usual maternity care. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked by the second reviewer. MAIN RESULTS: Thirteen trials were included. The relative risk for stopping exclusive feeding within two months was 0. 83, 95% confidence interval 0.72 to 0.96. The relative risk for stopping breastfeeding within two months was 0.74, 95% confidence interval 0.65 to 0.86. One more mother will breastfeed for two months if support is provided for nine women (95% confidence interval 6 to 21). Similarly, one more woman will breastfeed exclusively if support is given to nine women (95% confidence interval 6 to 40). REVIEWER'S CONCLUSIONS: The provision of extra support by professionals with special skills in breastfeeding appears to result in more mothers breastfeeding their babies until two months of age, and more mothers breastfeeding their babies exclusively to two months of age.

Breast Feeding↗
PubMed2004

Hip protectors for preventing hip fractures in the elderly.

BACKGROUND: Hip fracture in the elderly usually results from a fall on the hip. Hip protectors have been advocated as a means to reduce the risk of sustaining a hip fracture. OBJECTIVES: To determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register (February 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February Week 2 2004), EMBASE (1988 to 2004 Week 08), CINAHL (1982 to February Week 2 2004), other databases and reference lists of relevant articles. We also contacted trialists. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. We sought additional information from all trialists. MAIN RESULTS: An additional trial with 4169 participants was included in this update, giving a total of 14 included trials. One, which was a study of compliance (adherence) lasting 12 weeks, contributed no fracture outcome data. Five studies involving 4316 participants were cluster randomised by care unit, nursing home or nursing home ward rather than by the individual. Each of these studies reported a reduced incidence of hip fractures within those units allocated to receive the protectors. Because the majority of these trials had not been analysed to allow for clustering, pooling of their results was not undertaken. Pooling of data from five individually randomised trials conducted in nursing/residential care settings (1426 participants) showed no significant reduction in hip fracture incidence (hip protectors 37/822, controls 40/604, relative risk (RR) 0.83, 95% confidence interval (CI) 0.54 to 1.29). Three individually randomised trials of 5135 community dwelling participants, reported no reduction in hip fracture incidence with the hip protectors (RR 1.16, 95% CI 0.85 to 1.59). No important adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. REVIEWERS' CONCLUSIONS: There is no evidence of effectiveness of hip protectors from studies in which randomisation was by individual patient within an institution, or for those living in their own homes. Data from cluster randomised studies indicate that, for those living in institutional care with a high background incidence of hip fracture, a programme of providing hip protectors appears to reduce the incidence of hip fractures. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.

Aged↗