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PubMed2004

Systematic review of progressive resistance strength training in older adults.

BACKGROUND: The aim of this systematic review was to quantify the effectiveness of progressive resistance strength training (PRT) to reduce physical disability in older people. METHODS: Randomized controlled trials were identified from searches of relevant databases and study reference lists and contacts with researchers. Two reviewers independently screened the trials for eligibility, rated their quality, and extracted data. Only randomized controlled trials utilizing PRT as the primary intervention in participants, whose group mean age was 60 years or older, were included. Data were pooled using fixed or random effect models to produce weighted mean differences (WMD) and 95% confidence intervals (CI). Standardized mean differences (SMD) were calculated when different units of measurement were used for the outcome of interest. RESULTS: 62 trials (n = 3674) compared PRT with a control group. 14 trials had data available to allow pooling of disability outcomes. Most trials were of poor quality. PRT showed a strong positive effect on strength, although there was significant heterogeneity (41 trials [n = 1955], SMD 0.68; 95% confidence interval [CI] 0.52, 0.84). A modest effect was found on some measures of functional limitations such as gait speed (14 trials [n = 798], WMD 0.07 meters per second; 95% CI 0.04, 0.09). No evidence of an effect was found for physical disability (10 trials [n = 722], SMD 0.01; 95% CI -0.14, 0.16). Adverse events were poorly investigated, but occurred in most studies where they were defined and prospectively monitored. CONCLUSIONS: PRT results in improvements to muscle strength and some aspects of functional limitation, such as gait speed, in older adults. However, based on current data, the effect of PRT on physical disability remains unclear. Further, due to the poor reporting of adverse events in trials, it is difficult to evaluate the risks associated with PRT.

Age Factors↗
PubMed2001

Psychiatric disorders in cancer patients: descriptive analysis of 1721 psychiatric referrals at two Japanese cancer center hospitals.

BACKGROUND: Although a diagnosis of cancer today may no longer be considered to be the equivalent of a death sentence, many previous studies in Western countries have revealed that such a diagnosis places many kinds of emotional burden on a patient. However, few studies have focused on the nature of psychiatric disorders in Japanese cancer patients. METHODS: We investigated the characteristics, reason for psychiatric consultation and psychiatric diagnosis of cancer patients by analyzing the database of patients referred to the Psychiatry Divisions at the National Cancer Center Hospital and the National Cancer Center Hospital East, Japan. RESULTS: Among a total of 1721 referrals, most of the cancer patients (78%) were inpatients. Patients with lung cancer (19%) were the most common, followed by patients with breast cancer (13%) and with head and neck cancer (10%). More than half of the patients had recurrent and/or metastatic cancer and 60% of the patients had pain. The most common reason for the consultation was psychiatric evaluation (35%), followed by sleep disorders (19%), anxiety or fear (18%) and depression (18%). Regarding the psychiatric diagnosis, adjustment disorders were the most common (34%), followed by delirium (17%) and major depression (14%). The diagnosis of cancer had been disclosed to more than 99% of the patients. CONCLUSION: The common psychiatric disorders observed in Japanese cancer patients were similar to those in the Western countries provided the cancer diagnosis is disclosed.

Adolescent↗
PubMed2006

Statins, fibrates, and melanoma risk: a systematic review and meta-analysis.

BACKGROUND: Large randomized, controlled clinical trials of lovastatin and gemfibrozil for heart disease prevention have reported statistically significantly lower melanoma incidences in persons receiving these medications. Results of in vitro animal model and human case-control studies also suggest that statins and fibrates may reduce the risk of melanoma. METHODS: We performed a systematic review of trials that randomly assigned participants to receive statins or fibrates versus an alternative therapy for a minimum of 6 months. Trials were identified by searching five electronic databases and the reference lists of eligible publications. Unpublished data were solicited from trial investigators and pharmaceutical companies. A meta-analysis was performed using a fixed-effects model, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate pooled treatment effects. All statistical tests were two-sided. RESULTS: We obtained data on incident melanomas from 20 of 36 qualifying randomized controlled trials (12 statin trials and eight fibrate trials), with a total of 70,820 participants. A total of 127 melanomas occurred among the 39,426 participants in the statin trials (59 among the 19,872 statin group participants and 68 among the 19,554 control group participants). A total of 27 melanomas occurred among the 31,394 participants enrolled in the fibrate trials (seven among the 12,324 fibrate group participants and 20 among the 19,070 control group participants). Overall, incidence of melanoma was not statistically significantly associated with the use of either statins (OR = 0.87, 95% CI = 0.61 to 1.23) or fibrates (OR = 0.45, 95% CI = 0.20 to 1.01). In a subgroup analysis by drug, only lovastatin use (in one trial) was statistically significantly associated with lower incidence of melanoma (OR = 0.52, 95% CI = 0.27 to 0.99). CONCLUSIONS: These findings do not validate the possibility that statins or fibrates prevent melanoma.

Atorvastatin↗
PubMed2006

Hierarchical clustering algorithm for comprehensive orthologous-domain classification in multiple genomes.

Ortholog identification is a crucial first step in comparative genomics. Here, we present a rapid method of ortholog grouping which is effective enough to allow the comparison of many genomes simultaneously. The method takes as input all-against-all similarity data and classifies genes based on the traditional hierarchical clustering algorithm UPGMA. In the course of clustering, the method detects domain fusion or fission events, and splits clusters into domains if required. The subsequent procedure splits the resulting trees such that intra-species paralogous genes are divided into different groups so as to create plausible orthologous groups. As a result, the procedure can split genes into the domains minimally required for ortholog grouping. The procedure, named DomClust, was tested using the COG database as a reference. When comparing several clustering algorithms combined with the conventional bidirectional best-hit (BBH) criterion, we found that our method generally showed better agreement with the COG classification. By comparing the clustering results generated from datasets of different releases, we also found that our method showed relatively good stability in comparison to the BBH-based methods.

Algorithms↗
PubMed2004

Typical and atypical Cogan's syndrome: 32 cases and review of the literature.

OBJECTIVE: To report our experience on a multicentre series of 32 patients with either typical or atypical Cogan's syndrome, to combine our results with a detailed review of the literature, and to compare the clinical manifestations of typical and atypical Cogan's syndrome. METHODS: Patients were identified from a survey conducted with physicians affiliated to the French National Society for Internal Medicine, and were classified into typical or atypical Cogan's syndrome according to the Haynes criteria. Clinical data were collected in a standardized manner. A comprehensive literature review using the Medline database and the reference lists of identified articles was performed. RESULTS: Seventeen patients had typical Cogan's syndrome and 15 had atypical Cogan's syndrome. Apart from non-syphilitic interstitial keratitis, the ocular manifestations of patients with atypical Cogan's syndrome were mainly uveitis and episcleritis. All but one patient presented with Ménière-like syndrome, and at the end of follow-up 11 were deaf and 19 additional patients had developed a significant decrease in auditory acuity. Twenty-five patients (78%) developed systemic manifestations, including aortitis in four. Comparison of typical and atypical Cogan's syndrome showed that some systemic manifestations were more common in atypical Cogan's syndrome, but these differences may be explained by reporting bias in the literature. CONCLUSION: Differences regarding the associated systemic manifestations of typical and atypical Cogan's syndrome may reflect reporting bias in the literature. However, the diversity of the ocular and audiovestibular manifestations and the acceptable lengthy delay between the two types of involvement in atypical Cogan's syndrome should make one cautious before accepting this diagnosis as the diagnosis may mimic various other systemic diseases.

Adolescent↗
PubMed1998

Ejection fraction improvement by beta-blocker treatment in patients with heart failure: an analysis of studies published in the literature.

Because ejection fraction (EF) is one of the most important predictors of survival in patients with left ventricular (LV) dysfunction and because Packer showed a large reduction in mortality figures with carvedilol, in contrast to former studies with bisoprolol and metoprolol, we investigated if this difference in survival may be related to a difference in improvement of LV function by different beta-blockers. We searched the MEDLINE database and all reference lists of articles obtained through the search for the relation between beta-blocker treatment and improvement in EF. Forty-one studies met the criteria and we added two of our own studies. Four hundred and fifty-eight patients were treated with metoprolol with a mean follow-up of 9.5 months and a mean increase in EF of 7.4 EF units. One thousand thirty patients were treated with carvedilol with a mean follow up of 7 months and a mean increase in EF of 5.7 EF units. One hundred ninety-nine patients were treated with bucindolol with a mean follow-up of 4 months and a mean increase in EF of 4.6 EF units. Several small studies with nebivolol, atenolol, and propranolol were also studied and, when combined, the mean increase in EF was 8.6 EF units. When patients with idiopathic and ischemic cardiomyopathies were compared, the average increase in EF units was 8.5 vs. 6.0, respectively. The use of beta-blocker treatment in heart failure patients, irrespective of the etiology, improved LV function in almost all studies and it appears that the differences among beta-blockers and among etiologies is small and probably insignificant. However, there is a difference in survival rate when the various beta-blockers are compared, suggesting that mechanisms other than improvement of LV function by beta-blockers are responsible for the difference in survival.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials.

PURPOSE: Use the meta-analytic approach to examine the effects of aerobic exercise on lipids and lipoproteins in adults with cardiovascular disease (CVD). METHODS: Studies were retrieved via electronic databases, review of reference lists from retrieved articles, including reviews, and hand searching. Inclusion criteria were: (1) randomized controlled trials, (2) aerobic exercise >or=4 weeks as an intervention, (3) studies published in English language only between January 1, 1955 and January 1, 2005, (4) studies published in journals or as dissertations or master's theses, (5) human subjects >or=18 years, (6) all subjects diagnosed with some type of CVD, and (7) pre and post data available for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and/or triglycerides (TG). Random-effects models were used for data analysis. RESULTS: Of the more than 3,000 studies reviewed, a total of 10 representing 1,260 subjects (580 exercise, 680 control) were included in our analysis. There was a statistically significant increase of 9% in HDL-C (mean +/- SEM, 3.7 +/- 1.3 mg/dL; 95% CI, 1.2 to 6.1 mg/dL) and a statistically significant decrease of 11% in TG (-19.3 +/- 5.4 mg/dL; 95% CI, -30.1 to -8.5 mg/dL), but no statistically significant decreases in TC or LDL-C (TC, -8.8 +/- 6.8 mg/dL; 95% CI, -22.3 to 4.7 mg/dL; LDL-C, -7.7 +/- 6.0 mg/dL; 95% CI, -19.5 to 4.2 mg/dL). CONCLUSIONS: The present findings suggest that chronic aerobic exercise increases HDL-C and decreases TG in adults, especially men, with CVD.

Biomarkers↗
PubMedDate not supplied

A systematic review of the safety of black cohosh.

OBJECTIVE: To systematically review the available data relating to the safety of medicinal extracts of black cohosh (Actaea racemosa). DESIGN: Systematic literature searches were conducted in seven electronic databases, and the reference lists of all papers located were checked for further relevant publications. Information was also sought from the spontaneous reporting programs of the World Health Organization and national drug safety bodies. Sixteen manufacturers of black cohosh preparations were contacted and asked for data held on file. Finally, our own departmental files were searched. No language restrictions were imposed. Combination products and homeopathic preparations were excluded. RESULTS: Data from clinical studies and spontaneous reporting programs suggest that adverse events (AEs) with black cohosh are rare, mild, and reversible. Gastrointestinal upsets and rashes are the most common AEs. The spontaneous reporting programs do contain a few serious AEs, including hepatic and circulatory conditions, but causality cannot be determined. Although there is large amount of data investigating the efficacy of black cohosh, in particular the product Remifemin, safety issues and the monitoring of AEs have not been the focus. CONCLUSION: If black cohosh products are taken for a limited length of time, there seems to be a slight risk of mild, transient AEs. More serious AEs seem to be rare, and it is impossible to ascertain causality with black cohosh with the limited data available. Thus, although definitive evidence is not available, it would seem that black cohosh is a safe herbal medicine.

Cimicifuga↗
PubMed2001

Ability of peripapillary atrophy parameters to differentiate normal-tension glaucoma from glaucomalike disk.

PURPOSE: To investigate the ability of peripapillary atrophy (PPA) parameters to differentiate normal-tension glaucoma (NTG) from glaucomalike disk (GLD). METHODS: Thirty-three eyes of 33 patients with GLD that had no evidence of visual field defect and retinal nerve fiber layer defect and 33 eyes of 33 patients with NTG, matched with age and intraocular pressure, were enrolled. The participants were selected from the database of patients referred from a routine health checkup because of high cup-to-disk ratio (>0.5). Topographic measurements for the optic disk were performed using the Heidelberg Retina Tomograph (HRT). The extent of PPA (zone beta) was measured with Atrophy Zone Analysis software of HRT. Receiver operating characteristic (ROC) curves (GraphROC version 2.0) were used to compare the new formula including PPA parameters with that of the HRT discriminant analysis formula in differentiating NTG from GLD. RESULTS: The area of zone beta, atrophy-to-disk area ratio, and angular and radial extent of zone beta were significantly larger in NTG (P < 0.01). Multiple logistic regression analysis showed that rim area and corrected radial extent of zone beta are variables that show significant difference between NTG and GLD (P < 0.05). The area under the ROC curve for the new formula including rim area and corrected radial extent of zone beta (0.8655) was significantly larger than that for the HRT discriminant analysis formula (0.7351) (P = 0.0128). CONCLUSION: The PPA measurement obtained by HRT can be a useful additional tool to differentiate NTG from GLD after the first screening by disk photograph in a routine health checkup.

Adult↗
PubMedDate not supplied

Oral methadone for chronic noncancer pain: a systematic literature review of reasons for administration, prescription patterns, effectiveness, and side effects.

OBJECTIVE: To assess the indications, prescription patterns, effectiveness, and side effects of oral methadone for the treatment of chronic noncancer pain. METHODS: We conducted searches of several electronic databases, textbooks and reference lists for controlled or uncontrolled studies in humans. Effectiveness was assessed using a dichotomous classification of "meaningful" versus "nonmeaningful" outcomes. RESULTS: Twenty-one papers (1 small randomized trial, 13 case reports, and 7 case series) involving 545 patients with multiple noncancer pain conditions were included. In half of the patients, no specific diagnosis was reported. Methadone was administered primarily when previous opioid treatment was ineffective or produced intolerable side effects. Starting dose ranged from 0.2 to 80 mg/day and maximum dose ranged from 20 to 930 mg/day. Pain outcomes were meaningful in 59% of the patients in the uncontrolled studies. The randomized trial demonstrated a statistically significant improvement in pain for methadone (20 mg/day) compared to placebo. Side effects were considered minor. DISCUSSION: Oral methadone is used for various noncancer pain syndromes, at different settings and with no prescription pattern that could be identifiable. Starting, maintenance, and maximum doses showed great variability. The figure of 59% effectiveness of methadone should be interpreted very cautiously, as it seems overrated due to the poor quality of the uncontrolled studies and their tendency to report positive results. The utilization of oral methadone for noncancer pain is based on primarily uncontrolled literature. Well-designed controlled trials may provide more accurate information on the drug's efficiency in pain syndromes and in particular neuropathic pain.

Administration, Oral↗
PubMed2005

A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation-or, back school treatment outcome in patients with chronic low back pain.

STUDY DESIGN: A systematic review. OBJECTIVE: To determine predictors of outcome of multidisciplinary rehabilitation-or back school treatment for patients with chronic low back pain. SUMMARY OF BACKGROUND DATA: Numerous reviews have been performed to gain insight into which patients benefit from which treatment. However, no review has systematically focused on predictors from multiple domains (i.e., sociodemographic, physical, and psychological), or on treatment outcome measured as activity limitation or participation restriction. METHODS: Studies were found by searching medical and psychological databases, and screening references. Two reviewers independently assessed the methodological quality using standard criteria. Studies were only included if they met a predefined level of internal validity. A qualitative analysis was performed. RESULTS: Heterogeneity among studies in patient characteristics, predictors, treatment, and outcomes limited evidence. All reviewed studies were descriptive or exploratory in nature. Consistent evidence was found for the predictive value of pain intensity (more pain--> worse outcome), several work-related parameters (e.g., high satisfaction--> better outcome), and coping style (less active coping--> better outcome). Other sociodemographic and physical variables consistently lacked predictive value. No consistent evidence was found for other psychological variables. CONCLUSIONS: It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the reviewed studies were descriptive or exploratory in nature, and most predictors were only studied once. Nevertheless, for several predictors, consistent evidence was found. Large confirmatory studies are needed to test the value of these predictors.

Chronic Disease↗
PubMed2006

Personal digital assistants change management more often than paper texts and foster patient confidence.

INTRODUCTION: Rapid retrieval of information, including drug treatment options, is critical to emergency department practice. OBJECTIVES: To assess feasibility and patient acceptance of personal digital assistants and to determine the scope of management changes. METHODS: Emergency medicine residents (EMRs, n = 18) and emergency medicine attending (EMAs, n = 12) used personal digital assistants with drug database and clinical references. Text versions were also available in the emergency department. We did a prospective, random, cross-over time-motion study, recording retrieval time, source, and changes to patient care for 16 and 8 h for EMRs and EMAs, respectively. We surveyed patients for confidence in EMRs and EMAs with personal digital assistants, and perceived efficiency. RESULTS: EMRs accessed paper (n = 131) or personal digital assistant (n = 181) information on 92.3% of patients (n = 17, both). They accessed personal digital assistant on 61.4% of patients vs. 44.5% with texts (odds ratio 1.99, 95% confidence interval 1.4-2.80). Mean access times were 9.3 and 9.4 s, respectively, +1.4 for both. Personal digital assistant access was 75%/25% between pharmacopeia and clinical resource. Personal digital assistants changed drug choice in 39/181 patients (21.5%), and other management (diagnosis, treatment or disposition) in 15/181 patients (8.3%). Odds ratio for change in management for personal digital assistant vs. paper was 2.00 (95% confidence interval 1.11-3.60). We surveyed patient perception for 198 of 295 patients (67.1%). Fifty percent reported more confidence in their EMRs and EMAs with a personal digital assistant, while 5% reported less confidence. Sixty percent agreed strongly that there is too much medical information to remember. CONCLUSIONS: Personal digital assistants are feasible in an academic emergency department and change management more often than texts. EMRs accessed personal digital assistants more often than paper texts. Patient perceptions of physicians who use personal digital assistants are neutral or favorable.

Attitude of Health Personnel↗
PubMed2006

Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review.

INTRODUCTION: Prevalence estimates of osteopenia and osteoporosis (reduced bone mineral density; BMD) in HIV-infected patients and the role of antiretroviral therapy (ART) varies in the literature. METHODS: We conducted a meta-analytical review of cross-sectional studies published in English to determine the pooled odds ratios (OR) of reduced BMD and osteoporosis in the following groups: HIV-positive versus HIV-negative; ART-treated versus ART-naive; protease inhibitor (PI)-treated versus PI-untreated. We searched the MEDLINE, PubMed, and EMBASE databases for eligible references between January 1966 and November 2005. Random effects models were used to generate pooled OR estimates and confidence intervals. RESULTS: Of 37 articles identified, 20 met the inclusion criteria. Of the 884 HIV-infected patients, 67% had reduced BMD, of whom 15% had osteoporosis, yielding a pooled OR of 6.4 and 3.7, respectively, compared with HIV-uninfected controls (n = 654) using 11 studies with available data. Compared with ART-naive patients (n = 202, 10 studies), ART-treated individuals (n = 824) had a 2.5-fold increased odds of prevalent reduced BMD. The risk of prevalent osteoporosis (seven studies) was similarly elevated in ART-treated individuals. Compared with non-PI-treated HIV patients (n = 410, 14 studies), PI-treated patients (n = 791) had increased odds of reduced BMD and osteoporosis (12 studies). Few studies adjusted for important covariates such as HIV disease severity or treatment duration. CONCLUSION: The prevalence of osteoporosis in HIV-infected individuals is more than three times greater compared with HIV-uninfected controls. ART-exposed and PI-exposed individuals had a higher prevalence of reduced BMD and osteoporosis compared with their respective controls. The influence of other disease and treatment variables on these estimates could not be determined.

Adult↗
PubMed2004

Systematic recovery and analysis of full-ORF human cDNA clones.

The Mammalian Gene Collection (MGC) consortium (http://mgc.nci.nih.gov) seeks to establish publicly available collections of full-ORF cDNAs for several organisms of significance to biomedical research, including human. To date over 15,200 human cDNA clones containing full-length open reading frames (ORFs) have been identified via systematic expressed sequence tag (EST) analysis of a diverse set of cDNA libraries; however, further systematic EST analysis is no longer an efficient method for identifying new cDNAs. As part of our involvement in the MGC program, we have developed a scalable method for targeted recovery of cDNA clones to facilitate recovery of genes absent from the MGC collection. First, cDNA is synthesized from various RNAs, followed by polymerase chain reaction (PCR) amplification of transcripts in 96-well plates using gene-specific primer pairs flanking the ORFs. Amplicons are cloned into a sequencing vector, and full-length sequences are obtained. Sequences are processed and assembled using Phred and Phrap, and analyzed using Consed and a number of bioinformatics methods we have developed. Sequences are compared with the Reference Sequence (RefSeq) database, and validation of sequence discrepancies is attempted using other sequence databases including dbEST and dbSNP. Clones with identical sequence to RefSeq or containing only validated changes will become part of the MGC human gene collection. Clones containing novel splice variants or polymorphisms have also been identified. Our approach to clone recovery, applied at large scale, has the potential to recover many and possibly most of the genes absent from the MGC collection.

Cloning, Molecular↗
PubMed2006

Meta-analysis: antioxidant supplements for primary and secondary prevention of colorectal adenoma.

BACKGROUND: Colorectal cancer may be prevented by reducing the development of adenomatous polyps. AIM: To assess the benefits and harms of antioxidant supplements in preventing colorectal adenoma. METHODS: Using the Cochrane Collaboration methodology we reviewed all randomized clinical trials comparing antioxidant supplements with placebo or no intervention. We searched electronic databases and the reference lists until October 2005. Outcome measures were development of colorectal adenoma adverse events. We analysed dichotomous outcomes with fixed- and random-effects model meta-analyses and calculated the relative risk with 95% confidence interval. RESULTS: We identified eight randomized trials (17 620 participants). Neither fixed-effect (relative risk: 0.93, 95% CI: 0.81-1.1) nor random-effect model meta-analyses (0.82, 0.60-1.1) showed statistically significant effects of supplementation with beta-carotene, vitamins A, C, E and selenium alone or in combination. Antioxidant supplements seemed to increase the development of colorectal adenoma in three low-bias risk trials (1.2, 0.99-1.4) and significantly decrease its development in five high-bias risk trials (0.59, 0.47-0.74). The estimates difference is significant (P < 0.0001). There was no significant difference between the intervention groups regarding adverse events, including mortality (0.82, 0.47-1.4). CONCLUSION: We found no convincing evidence that antioxidant supplements have significant beneficial effect on primary or secondary prevention of colorectal adenoma.

Adult↗
PubMed2005

Effectiveness of single- versus multiple-visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta-analysis.

AIM: The clinical question this review aimed to answer is: does single-visit root canal treatment without calcium hydroxide dressing, compared to multiple-visit treatment with calcium hydroxide dressing for 1 week or more, result in a lower healing (success) rate (as measured by clinical and radiographic interpretation)? METHODOLOGY: CENTRAL, MEDLINE, EMBASE and HEALTH STAR databases were used. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through Science Citation Index to identify potentially relevant subsequent primary research. REVIEW METHODS: The included studies were randomized controlled clinical trials (RCTs) comparing healing rate of single- and multiple-visit root canal treatment in humans. The outcome measured was healing of radiographically detectable lesions. Data in those studies were independently extracted. RESULTS: Only three RCTs were identified and included in the review, covering 146 cases. Sample size of all three studies was small; none demonstrated a statistically significant difference in healing rates. Risk differences of included studies were combined using the inverse variance-weighted method (RD(Pooled) = -6.3%; 95% CI: -20.3-7.8). CONCLUSION: Based on the current best available evidence, single-visit root canal treatment appeared to be slightly more effective than multiple visit, i.e. 6.3% higher healing rate. However, the difference in healing rate between these two treatment regimens was not statistically significant (P = 0.3809).

Calcium Hydroxide↗
PubMed2007

Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis.

AIM: To determine to what extent does calcium hydroxide intracanal medication eliminate bacteria from human root canals, compared with the same canals before medication, as measured by the number of positive cultures, in patients undergoing root canal treatment for apical periodontitis (teeth with an infected root canal system). METHODOLOGY: CENTRAL, MEDLINE and EMBASE databases were searched. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through the Science Citation Index to identify potentially relevant subsequent primary research. REVIEW METHODS: The included studies were pre-/post-test clinical trials comparing the number of positive bacterial cultures from treated canals. Data in those studies were independently extracted. Risk differences of included studies were combined using the generic inverse variance and random effect method. RESULTS: Eight studies were identified and included in the review, covering 257 cases. Sample size varied from 18 to 60 cases; six studies demonstrated a statistically significant difference between pre- and post-medicated canals, whilst two did not. There was considerable heterogeneity among studies. Pooled risk difference was -21%; 95% CI: -47% to 6%. The difference between pre- and post-medication was not statistically significant (P = 0.12). CONCLUSIONS: Calcium hydroxide has limited effectiveness in eliminating bacteria from human root canal when assessed by culture techniques.

Bacteria↗
PubMed2006

Effectiveness of sleep management strategies for residents of aged care facilities: findings of a systematic review.

AIMS AND OBJECTIVES: The objectives of this systematic review were to determine the most effective tools for the assessment and diagnosis of sleep problems, as well as identify the most effective strategies for the promotion of sleep within this population. BACKGROUND: Experiencing reduced sleep quality is often associated with normal ageing, however this may be exacerbated for residents of aged care facilities. External factors such as noise, light and night-time nursing may impact negatively upon sleeping patterns. METHODS: Eleven electronic databases and the reference lists and bibliographies of included studies were searched. Papers were grouped according to type of intervention or assessment tool and presented in a narrative summary. CONCLUSIONS: The review identified many interventions to promote sleep. Multidisciplinary strategies such as combining a reduction in environmental noise, reduction of night-time nursing care and promotion of daytime activity, are likely to be most effective for promoting sleep in the population of interest. The use of sedating medications is cautioned, as their long-term efficacy in promoting sleep is questionable. Wrist actigraphy was found to be the most accurate objective sleep assessment tool. RELEVANCE TO CLINICAL PRACTICE: Lack of sleep, disturbed sleep and the overuse of medications especially sedations reduce the quality of life for older people. Effective, safe sleep interventions should be promoted and practised by nurses.

Aged↗