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PubMed2006

Chiropractic treatment of lower extremity conditions: a literature review.

OBJECTIVE: The purpose of this study was to document the quantity and type of research conducted on the chiropractic management of lower extremity conditions. METHODS: A review of the literature was conducted using the CINAHL, MEDLINE, MANTIS, and Science Direct databases (each from inception to December 15, 2005). Search terms included chiropractic, hip, knee, ankle, foot, with Medical Subject Heading terms for each region. Inclusion criteria included studies with a lower extremity diagnosis, and the treatment was performed by doctors of chiropractic. Articles were excluded if pain was referred from spinal sites and if there was a duplicate publication; articles published in non-peer-reviewed literature and abstracts in conference proceedings were also excluded. Of the articles identified, an analysis was conducted assessing those including peripheral and/or spinal treatment. Clinical trials were assessed for quality using the Physiotherapy Evidence Database scale. RESULTS: There was a total of 1652 citations. Of these, 76 were deemed relevant; 24 were related to the foot, 10 to the ankle, 25 to the knee, and 17 to the hip. Twenty-nine citations included spinal treatment, 47 solely peripheral, and 2 solely spinal. Ten citations were clinical trials and scored on the Physiotherapy Evidence Database scale. CONCLUSIONS: Literature on the chiropractic management of lower extremity conditions has a large number of case studies (level 4 evidence) and a smaller number of higher-level publications (level 1-3 evidence). The management available in the peer-reviewed literature is predominantly multimodal and contains combined spinal and peripheral components. Future chiropractic research should use higher-level research designs, such as randomized controlled trials.

Ankle↗
PubMedDate not supplied

Research in chiropractic education: an update.

PURPOSE: The objectives of this review were to update the 1997 report on research in chiropractic education from the Research Agenda Conference in 1996 and to provide recommendations for the future direction of this research. METHODS: We conducted a review of the medical and chiropractic literature from March 1997 to March 2005 on the 7 thematic areas identified in the Research Agenda Conference's 1997 article (ie, curriculum, assessment, instructional methods, admissions, faculty development and evaluation, postgraduate and continuing education, and patient centeredness). We searched the following databases: MEDLINE, CINAHL, Alt HealthWatch, Index to Chiropractic Literature, MANTIS, and ERIC. We hand searched conference proceedings and relevant journals along with the reference lists of retrieved articles. DISCUSSION: Although research studies in chiropractic education have been conducted on the 7 cited thematic areas, much have focused on instruction, curriculum, assessment, and faculty development. Research studies on areas recommended in the 1997 article, such as patient centeredness and continuing education, are less evident. CONCLUSIONS: Researchers in chiropractic education need to focus their efforts on key areas of importance and interest. They should consider collaborating across the professions with individuals who share the same interest and who have a productive and successful research track record. Individual researchers should be willing to share and acknowledge the work of other colleagues in and across professions. One such area of research that meets these criteria and that which is recommended for consideration is professionalism.

Chiropractic↗
PubMed2005

Proceedings from the "Third International Conference on Mechanism of Action of Nutraceuticals".

The "Third International Conference on Mechanisms of Action of Nutraceuticals" (ICMAN 3) was held to bring investigators from around the world together to find answers and share experience relevant to the role of nutraceuticals in health and disease. Dietary supplements are currently receiving recognition as being beneficial in coronary heart disease, cancer, osteoporosis and other chronic and degenerative diseases such as diabetes, Parkinson's and Alzheimer's diseases. This gave impetus to investigate the mechanisms of action of nutraceuticals and related bioactive compounds in disease pathologies. Many lines of evidence indicate that the mechanistic actions of natural compounds involve a wide array of biological processes, including activation of antioxidant defenses, signal transduction pathways, cell survival-associated gene expression, cell proliferation and differentiation and preservation of mitochondrial integrity. Furthermore, many of these compounds exert anti-inflammatory actions through inhibition of oxidative stress-induced transcription factors (e.g., NF-kappaB, AP-1), cytotoxic cytokines and cyclooxygenase-2. It appears that these properties play a crucial role in the protection against the pathologies of numerous age-related or chronic diseases. This review summarizes the latest research finding in functional foods and micronutrients in the promotion of health and reduction of risk for major chronic diseases as presented in this symposium.

Antioxidants↗
PubMed2006

Management of high risk metastatic prostate cancer: the case for novel therapies.

PURPOSE: We reviewed the results of preliminary studies of select novel agents for metastatic prostate cancer and discuss the potential benefit of these agents for earlier stage disease, eg biochemically recurrent prostate cancer with high risk features. MATERIALS AND METHODS: Available data on select investigational immunotherapies as well as endothelin-A receptor antagonists and survivin inhibitors were obtained and reviewed through PubMed searches, conference proceedings and unpublished proprietary information, when available. RESULTS: A large number of promising agents are in varying stages of development. Phase III results have been reported for the endothelin-A receptor antagonist atrasentan. Several immunotherapies are currently in phase II/III trials, namely the GM-CSF transduced tumor cell vaccine GVAX, the prostatic acid phosphatase loaded dendritic cell vaccine Provenge and the prostate specific antigen expressing poxvirus vaccine PROSTVAC-VF. Another immunotherapy, the prostate specific membrane antigen immunoconjugate MLN2704 (Millennium Pharmaceuticals, Cambridge, Massachusetts), is in phase I/II study. The first clinical inhibitors of survivin are in early phase I studies. Several of these agents, including atrasentan, have shown statistically significant but modest effects in the advanced disease setting in which they have been studied. CONCLUSIONS: Clinical trial design with these novel therapies presents particular challenges since most of these agents may induce disease stabilization rather than disease regression. There is a risk of false-negative results and failure to recognize a potentially efficacious agent if these cytostatic agents are studied only in men with advanced, heavily pretreated disease in whom life expectancy is measured in months. We advocate the early referral and enrollment of men with high risk prostate cancer in clinical trials.

Antineoplastic Agents↗
PubMed2003

Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic review.

OBJECTIVE: Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted diseases in the United States. Perinatal transmission of the virus to the fetus or neonate is a major concern in affected pregnancies. Our objective was to systematically review published data to estimate the effect of prophylactic acyclovir provided to pregnant women near term on the rate of recurrent genital herpes at delivery; the number of cesarean deliveries performed for clinical HSV recurrences or prodromal symptoms; and the prevalence of HSV virologic detection at delivery. DATA SOURCES: Our search included MEDLINE (1966-March 2003), LILACS, EMBASE, conference proceedings, abstracts from scientific forums and bibliographies of published articles with the following medical headings: acyclovir, pregnancy, Herpes viridae, and Herpesviridae. METHODS OF STUDY SELECTION: Prospectively designed criteria included randomized, clinical trials detailing the use of acyclovir in pregnancy for women with HSV published in either abstract or article form. Five trials with a total enrollment of 799 patients were included in the analysis. TABULATION, INTEGRATION, AND RESULTS: The studies were reviewed independently by three of the authors. With RevMan software, a fixed-effects model was used to calculate a summary odds ratio (OR) comparing the effect of treatment with placebo. Acyclovir prophylaxis beginning at 36 weeks' gestation was effective in reducing clinical HSV recurrences at the time of delivery (OR 0.25; 95% confidence interval [95% CI] 0.15, 0.40), cesarean deliveries for clinical recurrence genital herpes (OR 0.30; 95% CI 0.13, 0.67), total HSV detection at delivery (OR 0.11; 95% CI 0.04, 0.31), and asymptomatic HSV shedding at delivery (OR 0.09; 95% CI 0.02, 0.39). CONCLUSION: The results of this meta-analysis indicate that prophylactic acyclovir beginning at 36 weeks' gestation reduces the risk of clinical HSV recurrence at delivery, cesarean delivery for recurrent genital herpes, and the risk of HSV viral shedding at delivery.

Acyclovir↗
PubMed2006

Antibiotics to improve recovery following tonsillectomy: a systematic review.

OBJECTIVE: To determine if antibiotics improve recovery following tonsillectomy. STUDY DESIGN DATA SOURCES: Electronic databases Medline, Embase, and Cochrane Controlled Trials Register were searched using relevant search terms. Additional trials, if any, were retrieved by searching the references from all identified trials, reviews, correspondences, editorials, and conference proceedings. No language restriction was applied. STUDY SELECTION: Systematic review of trials in which antibiotic was administered as a study medication intraoperatively and/or postoperatively, in children or adults undergoing tonsillectomy or adenotonsillectomy. Only randomized, placebo-controlled, double-blind trials attaining preset quality scores were included. Outcomes analyzed: 1) pain, need for analgesia, fever, halitosis, and return to normal diet and activities; 2) secondary hemorrhage using 2 parameters-significant hemorrhage (ie, warranting readmission, blood transfusion, or return to theatre for hemostasis) and total hemorrhage; and 3) adverse events. RESULTS: Five trials met the eligibility criteria. Antibiotics significantly reduced the number of subjects manifesting fever (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.45, 0.85) and duration of halitosis (-1.94 [-3.57, -0.30] days), and marginally reduced the time taken to resume normal activity (-0.63 [-1.12, -0.14] days), but had no significant effect in reducing pain scores (-0.01 [-0.60, 0.57]) or need for analgesia. Similarly, there was no significant difference in the time taken to resume normal diet or incidence of significant and total hemorrhage, although data was underpowered to detect differences for these outcomes. In the antibiotic group 4 patients developed an adverse reaction (3 cases of rash and 1 case of oropharyngeal candidiasis), while in the control group 1 patient had an adverse reaction (rash). The RR of antibiotic-related adverse events was 2.45 (0.45, 13.31). CONCLUSION: Antibiotics appear to be effective in reducing some, but not all, morbid outcomes following tonsillectomy, and may increase the risk of adverse events. Further trials are needed to better define the role of antibiotics in facilitating post-tonsillectomy recovery. EBM RATING: A-1a.

Adenoidectomy↗
PubMed2004

A meta-analysis of the milk-production response after anthelmintic treatment in naturally infected adult dairy cows.

Meta-analysis was used to estimate the effects of anthelmintic treatment on milk production in dairy cows. The literature search included peer-reviewed journals (both full articles and abstracts), conference proceedings and theses and included documents written in English, Spanish, French, Portuguese or Italian. The study outcome was defined as the difference in milk production (kg/cow per day) between treated and untreated cows. Random effect meta-analyses were performed on 75 trials published between 1972 and 2002. The combined estimate after controlling for publication bias and/or small-study effect was of 0.35 kg/cow per day. Significant variation among studies was detected and although several variables were associated with the study outcome, they did not significantly reduce the unexplained variability among trials. Trials reporting the use of endectocides had higher milk-production response compared with trials using older anthelmintics. Similarly, whole-herd treatment trials or trials which applied the treatment in mid-lactation or strategically throughout the year had higher response compared with calving or dry-period treatment trials. Trials reporting the results as total 305-day milk production had lower response compared with trials which measured production as daily milk weight. Primiparous cows trials had lower responses compared with multiparous cows trials.

Animals↗
PubMed2006

The role of radiation therapy in malignant pleural mesothelioma: a systematic review.

INTRODUCTION: Radiation therapy may offer patients presenting with malignant pleural mesothelioma (MPM) symptom palliation and improvements in quality of life. This systematic review will address the role of radiation therapy in the management of MPM. METHODS: A thorough systematic search of the literature was conducted for published articles and conference proceedings for applicable abstracts. Relevant trials were selected and assessed. RESULTS: Three small randomized controlled trials compared prophylactic external beam radiation therapy to no radiation therapy for patients with thoracic tracts caused by drainage tubes or diagnostic procedures. None of those trials reported any serious adverse effects. A pooled analysis found no significant reduction in the frequency of procedure tract metastases. Four non-comparative studies have shown that hemithoracic irradiation alone resulted in significant toxicity, including radiation-induced pulmonary fibrosis, radiation pneumonitis, and bronchopleural fistula, without any survival benefit. Few of the identified studies reported on symptom control, and no studies included formal measures of quality of life. CONCLUSION: There is limited evidence for the role of radiotherapy in the management of patients with MPM. Future studies including radiotherapy for the treatment of such patients should include formal measures of quality of life and symptom control.

Clinical Trials as Topic↗
PubMedDate not supplied

Lumbar discography: a comprehensive review of outcome studies, diagnostic accuracy, and principles.

BACKGROUND AND OBJECTIVES: Since its advent more than 50 years ago, the use of discography has been mired in controversy. The purpose of this review is to provide a clinical overview of lumbar discography and discogenic back pain, with special emphasis on determining the accuracy of discography and whether or not the procedure improves outcomes for surgery. METHODS: Material for this review was obtained from a MEDLINE search conducted from 1951 thru September 2004, bibliographic references, book chapters, and conference proceedings. RESULTS: Based on a large number of comparative studies, plain discography is less accurate than magnetic resonance imaging in diagnosing lumbar herniated nucleus pulposus and comparable or slightly more sensitive in detecting degenerative disc disease. For disc degeneration, CT discography remains the gold standard for diagnosis. There are very few studies comparing surgical outcomes between patients who have undergone preoperative provocative discography and those who have not. What little evidence exists is conflicting. Before disc replacement surgery, approximately half the studies have used preoperative discography. A comparison of outcomes did not reveal any significant difference between the 2 groups but none of the studies was controlled, and they used different outcome measures, follow-up periods, and surgical techniques. Because all intradiscal electrothermal therapy (IDET) studies have used discography before surgery, no conclusions can be drawn regarding its effects on outcome. CONCLUSIONS: Although discography, especially combined with CT scanning, may be more accurate than other radiologic studies in detecting degenerative disc disease, its ability to improve surgical outcomes has yet to be proven. In the United States and Europe, there are inconsistencies in the use of lumbar discography such that it is routinely used before IDET, yet only occasionally used before spinal fusion.

Costs and Cost Analysis↗
PubMed2004

The use of interferon alpha in Behçet disease: review of the literature.

OBJECTIVES: To evaluate the efficacy and safety of interferon (IFN) alpha for the treatment of Behçet's disease (BD) and discuss its possible mechanisms of action. METHODS: Reports published until July 2002 in all languages were identified by the PubMed Database and the BD conference proceedings and abstract booklets. The indexing terms used were "Behçet" and "interferon." RESULTS: Thirty-two original reports and 4 selected abstracts were included in the analysis. Systemic IFN-alpha was administered to 338 patients. One hundred eighty-two patients with acute ocular disease were treated with IFN-alpha. Two hundred sixty-four patients received IFN-alpha2a, and 74 received IFN-alpha2b. Eighty-six percent of the patients with mucocutaneous symptoms, 96% with arthritis, and 94% with uveitis exhibited a partial or complete response. Higher IFN doses were more effective than low-dose regimens and led to up to 56% long-term remissions after discontinuation of IFN-alpha were reported. IFN-alpha2a apparently was superior to IFN-alpha2b, with more complete remissions, but this probably was the result of a bias caused by the larger number of patients treated with IFN-alpha2a. Side effects were dose-dependent and similar to those noted in patients with hepatitis C. CONCLUSIONS: Although the comparability of the studies is hampered because of different study designs, IFN-alpha is effective for the treatment of BD. It was beneficial even in resistant posterior uveitis, in which long-term remissions with preservation of visual acuity was achieved. In contrast, mostly partial remissions were reported for mucocutaneous symptoms.

Adult↗
PubMed2006

The effects of antifracture therapies on the components of bone strength: assessment of fracture risk today and in the future.

OBJECTIVE: To summarize the current knowledge regarding the impact of the most common antifracture medications on the various determinants of bone strength. METHODS: Relevant English-language articles acquired from Medline from 1966 to January 2005 were reviewed. Searches included the keywords bone AND 1 of the following: strength, remodeling, microcrack, structure, mineralization, collagen, organic, crystallinity, osteocyte, porosity, diameter, anisotropy, stress risers, or connectivity AND alendronate, estrogen, etidronate, hormone replacement therapy, parathyroid hormone, risedronate, OR teriparatide. Abstracts from relevant conference proceedings were also reviewed for pertinent information. RESULTS: Antiresorptive therapies increase bone strength through decreasing bone turnover. This lower bone turnover results in a higher mean mineralization and decreases the number of active resorption pits within bone at any given time. These resorption pits are speculated to be areas of focal weakness and a higher number of them would, if all other things were equal, result in greater fragility. Parathyroid hormone therapy increases the rate of bone remodeling, which introduces many resorption pits, but this source of strength loss is thought to be compensated by rapid increases in bone mass. CONCLUSIONS: Both the antiresorptives, particularly bisphosphonates, and the parathyroid hormone therapy increase bone strength; however, the changes that are elicited to achieve this differ significantly.

Bone Density↗