Proceedings of the Second International Conference on Experimental and Clinical Reproductive Immunology. Amsterdam, The Netherlands, November 2000.
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Abortion, Habitual↗
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Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review.
PURPOSE: A systematic review was conducted to develop guidelines for radiotherapy in adult patients with newly diagnosed malignant glioma. METHODS: MEDLINE, CANCERLIT, the Cochrane Library, and relevant conference proceedings were searched to identify randomized trials and meta-analyses. RESULTS: Pooling of six randomized trials detected a significant survival benefit favouring post-operative radiotherapy compared with no radiotherapy (risk ratio, 0.81; 95% confidence interval, 0.74 to 0.88, P<0.00001). Two randomized trials demonstrated no significant difference in survival rates for whole brain radiation versus more local fields that encompass the enhancing primary plus a 2 cm margin. A randomized trial detected a small improvement in survival with 60 Gy in 30 fractions over 45 Gy in 20 fractions. Radiation dose intensification and radiation sensitizer approaches have not demonstrated superior survival rates compared with conventionally fractionated doses of 50-60 Gy. CONCLUSIONS: Post-operative external beam radiotherapy is recommended as standard therapy for patients with malignant glioma. The high-dose volume should incorporate the enhancing tumour plus a limited margin (e.g. 2 cm) for the planning target volume, and the total dose delivered should be in the range of 50-60 Gy in fraction sizes of 1.8-2.0 Gy. Radiation dose intensification and radiation sensitizer approaches are not recommended as standard care. For patients older than age 70, preliminary data suggest that the same survival benefit can be achieved with less morbidity using a shorter course of radiotherapy. Supportive care alone is a reasonable therapeutic option in patients older than age 70 with a poor performance status.
Adult↗
Further thoughts on research funding.
This commentary expands on concepts on research funding within emergency medicine as developed in Part I of the Future of Emergency Medicine Research Conference proceedings. Specifically, this article focuses on strategies to enhance the support of research emergency medicine and development of the research infrastructure in the specialty.
Academic Medical Centers↗
Challenges with studies investigating longevity of dental restorations--a critique of a systematic review.
OBJECTIVES: A systematic review is a method of evaluating the published and unpublished literature relating to a specific area or topic. The objectives of this paper are to identify and discuss problems encountered in synthesising the available literature; and to make recommendations for the future conduct and reporting of clinical trials that aim to determine the longevity of dental restorations. DATA SOURCES: Studies were identified by a wide search of published and unpublished material in any language using a large number of general and specialist data bases, hand searching of key dental journals and searching of abstracts from conference proceedings. STUDY SELECTION: Pre-defined inclusion criteria based on objective outcome measures of restoration longevity and study designs were applied to determine study selection. CONCLUSIONS: A review of the longevity of dental restorations completed recently encountered substantial problems in designing an appropriate protocol to address this issue. The review found that many of the factors reported previously as affecting restoration longevity could not be confirmed using the agreed systematic review protocol that incorporated an objective study design. Further, the multiplicity of study designs, and reporting methods found in the literature made meta-analyses impossible. A proforma is proposed in order to aid the design of future research into the longevity of restorations.
Dental Materials↗
Is acupuncture effective for the treatment of chronic pain? A systematic review.
Pain is the major complaint of the estimated one million U.S. consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, the effectiveness of acupuncture for chronic pain remains in question. Our aim was to assess the effectiveness of acupuncture as a treatment for chronic pain within the context of the methodological quality of the studies. MEDLINE (1966-99), two complementary medicine databases, 69 conference proceedings, and the bibliographies of other articles and reviews were searched. Trials were included if they were randomized, had populations with pain longer than three months, used needles rather than surface electrodes, and were in English. Data were extracted by two independent reviewers using a validated instrument. Inter-rater disagreements were resolved by discussion. Fifty one studies met inclusion criteria. Clinical heterogeneity precluded statistical pooling. Results were positive in 21 studies, negative in 3 and neutral in 27. Three fourths of the studies received a low-quality score and low-quality trials were significantly associated with positive results (P=0.05). High-quality studies clustered in designs using sham acupuncture as the control group, where the risk of false negative (type II) errors is high due to large sample size requirements. Six or more acupuncture treatments were significantly associated with positive outcomes (P=0.03) even after adjusting for study quality. We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care. However, we have found an important relationship between the methodology of the studies and their results that should guide future research.
Acupuncture Therapy↗
Proceedings of the Vth International Conference on Hormones, Brain, and Behavior (Torino, Italy, August 25-30, 1996).
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Animals↗
Guidelines and methodological reviews concerning drug abuse liability assessment.
Regulatory control of drugs with abuse liability is an important component of drug control policy and is believed to help prevent nonmedical use. To be maximally effective, this requires a scientific assessment of abuse liability of drugs considered for regulatory control. These assessments have relied extensively on laboratory-based animal and human testing, but also utilize information from clinical trials, actual abuse and other sources. Here, we discuss recommendations and guidelines that have been proposed for abuse liability assessment and describe important review papers and conference proceedings that have addressed this matter, focusing primarily on drugs with medical usefulness. Historically, there is substantial consensus about how to approach abuse liability evaluation of drugs with actions similar to those of abused opiates, stimulants, depressants, and to a somewhat lesser extent, cannabinoids and hallucinogens, and much of what has been recommended for abuse potential assessment in the past remains valid and useful. On the other hand, novel CNS-active medications which cannot be readily classified with these traditional drugs of abuse are increasingly under development. In addition, advances in the science of abuse liability assessment need to be incorporated into future guidelines and recommendations on this subject. Developers of new medications need guidance on how to utilize scientific research to maximize therapeutic benefit while minimizing risk for abuse. Thus, another goal of this review has been to identify areas where critical thinking and new guideline development are needed.
Animals↗
Production of adenovirus vector for gene therapy.
The field of gene therapy is rapidly expanding with a major focus on the treatment of cancer. Replication-defective adenoviruses are vectors of choice for delivering corrective genes into human cells. Major efforts are directed to design new generations of adenoviral vectors that feature reduced immunogenicity and improved targeting ability. However, the production of adenoviral vectors for gene therapy applications faces a number of challenges that limit the availability of high quality material at the early stages of research and development in the gene therapy field. Moreover, very few papers have been published on the subject and information on large-scale production methods are only available through specialized conference proceedings. This review outlines the problems associated with mass production of adenovirus vectors and describes research efforts by a number of groups who have contributed to optimize production methods. Better understanding of the adenovirus infection and replication kinetics as well as better understanding of complementing cell line physiology and metabolism greatly contributed to improving vector titers and volumetric productivity at higher cell densities. Also, the critical aspect of viral vector quantitation is discussed.
Journal Article↗
Research and oncology nursing practice.
OBJECTIVE: To trace the evolution of oncology nursing research and to discuss its contribution to oncology nursing practice and health care. DATA SOURCES: Articles, textbooks, organizational documents, conference proceedings, and personal communication. CONCLUSIONS: Placing research in perspective will help suggest where we should go as a nursing specialty to provide excellent cancer care to patients, families, communities, and populations. It will also suggest directions for research priorities and for conceptual, methodologic, and health policy activities. IMPLICATIONS FOR NURSING PRACTICE: To influence oncology care, it is essential that oncology nurse researchers be responsive to trends that are relevant to both the conduct and utilization of oncology nursing research.
History, 20th Century↗
Predisposition testing for breast and ovarian cancer susceptibility.
OBJECTIVES: To provide an overview of breast cancer predisposition syndromes and the breast and Ovarian cancer susceptibility genes identified to date. To describe the clinical implications of genetic testing for breast and ovarian cancer susceptibility. DATA SOURCES: Published research and educational manuscripts, books, conference proceedings, and personal experiences. CONCLUSION: Nurses must become knowledgeable of predisposition genetic testing for inherited breast cancer risk including: understanding of the gene being analyzed and associated cancer risks, indications for testing, the limitations of the test, the management options for mutation carriers, risks and benefits of testing, and the long-term psychosocial sequelae. IMPLICATIONS FOR NURSING PRACTICE: Predisposition testing for alterations in breast cancer susceptibility genes is rapidly moving into the general oncology and primary care community where nurses will play a major role in the provision of genetic services. The role of nursing in cancer genetics includes practice and education, nursing research, and policy initiatives.
Breast Neoplasms↗
Forty years and four surveys: how does our measuring measure up?
OBJECTIVE: This article reviews four surveys methodologies that have been used over the past 40 years to assess immunization rates in young children in the United States. These methods include three national surveys: (1) United States Immunization Survey (1959-1985), which was first a household and then a telephone survey; (2) National Health Interview Survey (1991-present), which interviews people in their homes; and (3) National Immunization Survey (1994-present), a random-digit-dialing telephone survey. In addition, a series of retrospective school record surveys that used standard sampling and assessment methodologies were conducted nationally during 4 school years September 1990-May 1991. METHODS: Federal publications, National Immunization Conference proceedings, and Centers for Disease Control and Prevention (CDC) internal reports regarding national immunization surveys were reviewed. The methodology used in each survey is presented, and selected examples of previously tabulated results are presented. CONCLUSIONS: The assessment of immunization coverage in American preschool children requires ongoing commitment and survey expertise. Over the past 40 years the CDC's efforts to determine vaccination coverage in young children has evolved from the comparatively simple United States Immunization Survey to the current National Immunization Survey that utilizes sophisticated statistical and survey techniques to obtain the most-accurate results yet available.
Child↗
Exercise-induced asthma: diagnosis and management.
OBJECTIVE: To review the diagnosis and management of exercise-induced asthma (EIA). DATA SOURCES: Computer-assisted literature searches on MEDLINE for articles, abstracts, and other relevant data on exercise-induced asthma STUDY SELECTION: Published articles, abstracts, and conference proceedings were selected. RESULTS: EIA is seen in 40 to 90% of asthmatic patients. Exercise can be the sole trigger or be one of multiple triggers of asthma exacerbations. A good history and physical examination can diagnose most cases of EIA. Spirometry can confirm the diagnosis. Exercise testing may be necessary in certain cases. Prevention through both pharmacologic and nonpharmacologic measures is the key to EIA management. Inhaled beta-agonists remain the medications of choice for EIA prophylaxis. Inhaled cromolyn and antileukotrienes are alternatives. Good long-term control of asthma with anti-inflammatory medications such as inhaled steroids will also decrease the incidence of EIA. CONCLUSIONS: Early diagnosis and proper preventive and maintenance therapy can reduce episodes of EIA and enable patients to continue to engage in sports and lead an active life.
Adrenergic beta-Agonists↗
Pharmacotherapy for allergic rhinitis: a critical review of leukotriene receptor antagonists compared with other treatments.
OBJECTIVE: To review the mechanisms and clinical efficacy of leukotriene receptor antagonists, which are investigational therapies for allergic rhinitis, compared with intranasal corticosteroids and nonsedating antihistamines, which are the most commonly prescribed pharmacotherapies for allergic rhinitis. DATA SOURCES: Computer-assisted MEDLINE searches for articles and manual searches of conference proceedings on intranasal corticosteroid, antihistamine, leukotriene receptor antagonist, leukotriene modifier, zafirlukast, montelukast, allergic rhinitis, rhinitis, and asthma. SELECTION: Published articles and pertinent abstracts on the topics identified above were selected. Head-to-head comparator trials as well as data from placebo-controlled trials were selected. RESULTS AND CONCLUSIONS: The studies published to date demonstrate that leukotriene receptor antagonists are sometimes more effective than placebo, are no more effective than nonsedating antihistamines, and are less effective than intranasal corticosteroids in the treatment of allergic rhinitis. The combination of a leukotriene receptor antagonist and an antihistamine has not been proven to be more effective than either agent alone. This review reveals several inconsistencies that require resolution. First, whereas leukotriene receptor antagonists are predicted on the basis of their mechanism of action to improve nasal congestion significantly, clinical studies reveal leukotriene receptor antagonists to be no better than antihistamines at improving congestion. Second, leukotriene receptor antagonists would not be expected on the basis of their putative mechanism of action or nasal challenge data to improve significantly sneezing, nasal itching, or drainage. However, some studies show improvement in these symptoms during treatment with leukotriene receptor antagonists. Considered in aggregate, the data available to date do not clearly support a unique role of leukotriene receptor antagonists in the treatment of allergic rhinitis whether or not it is accompanied by asthma.
Adrenal Cortex Hormones↗
Medical treatment of allergic fungal sinusitis.
LEARNING OBJECTIVES: This review of allergic fungal sinusitis (AFS) will enable the reader to (1) differentiate AFS from the other forms of fungal sinusitis, (2) understand AFS pathophysiology, (3) recognize AFS clinical presentation, (4) prepare an effective treatment and follow-up strategy, and (5) avoid diagnostic and treatment pitfalls. DATA SOURCES: All English language MEDLINE articles that cross-referenced allergy, fungal, and sinusitis from 1983-present. Other MESH words referenced included: antibodies, fungal; fungus diseases; IgE; spores, fungal; rhinosinusitis. Additional referenced articles, published abstracts, and conference proceedings were also utilized. STUDY SELECTION: All case reports, studies, and review articles. RESULTS: Allergic fungal sinusitis is a distinct form of non-invasive fungal sinusitis. It is under-diagnosed, and incidence varies by region. Dematiaceous fungi predominate. In the southwestern United States, Bipolaris spicifera is the most common cause. Patients present with nasal polyps, rhinosinusitis, and occasionally proptosis. CT scans show hypertrophic sinusitis and often hyperattenuating allergic mucin within the sinus cavities. Extra-sinus extension of disease is common. Surgical histopathology shows eosinophilic-lymphocytic mucosal inflammation and inspissated allergic mucin containing non-invasive fungal hyphae. All patients are atopic and have positive allergy skin tests to the AFS organism. Total serum IgE levels are usually elevated. AFS immunopathophysiology is analogous to allergic bronchopulmonary aspergillosis. Treatment requires surgery, postoperative oral corticosteroids (OCS), and aggressive allergy management including allergen immunotherapy. Oral corticosteroids reduce disease activity and forestall the need for recurrent sinus surgery. Postoperative changes in total serum IgE mirror the clinical status and may predict disease recurrence. Patients should be cooperatively followed by the medical specialist and surgeon because early sinus surgery for recurrence, together with aggressive medical management, gives the best outcome. CONCLUSIONS: Allergic fungal sinusitis is a new allergic disorder with recognizable clinical and histopathologic findings. Treatment requires aggressive allergy management, postoperative OCS, monitoring of total serum IgE, and medical/surgical co-management.
Aspergillosis↗
Chlamydia pneumoniae, asthma, and COPD: what is the evidence?
LEARNING OBJECTIVES: Reading this article will familiarize the reader with (1) the unique chlamydial intracellular life cycle and the propensity for human chlamydial infections to become persistent and to result in immunopathologic (inflammatory) damage in target organs and (2) current evidence linking Chlamydia pneumoniae (Cpn) infection to obstructive lung diseases (asthma and chronic obstructive pulmonary disease, COPD). Potential therapeutic implications of the Cpn-asthma association are also discussed. DATA SOURCES: All Medline articles (January 1985 to March 1999) that cross-referenced the exploded MESH headings "lung diseases, obstructive" and "Chlamydia pneumoniae" (N = 76). Additional referenced articles, published abstracts, book chapters, and conference proceedings were also utilized. STUDY SELECTION: (1) Case reports and case series that identified Cpn infection in asthma and/or COPD and (2) epidemiologic studies of markers for Cpn infection in asthma and/or COPD that included one or more control groups. RESULTS: Of 18 controlled epidemiologic studies (over 4000 cases/controls), 15 found significant associations between Cpn infection and asthma using organism detection (polymerase chain reaction (PCR) testing (n = 2 studies) or fluorescent antigen testing (n = 1)), Cpn-specific secretory IgA (sIgA) antibody testing (n = 1), and/or specific serum IgE (n = 2), IgA (n = 4), IgG (n = 3) or other antibody criteria (n = 7). Eight case reports and 13 case series of Cpn infection in asthma (over 100 patients) also include descriptions of improvement or complete disappearance of asthma symptoms after prolonged antibiotic therapy directed against Cpn. Significant associations with COPD (over 1000 cases/controls) were reported in 5 of 6 studies. Results of treating chronic chlamydial infections in COPD patients have not been reported. CONCLUSIONS: Although the full clinical significance of these Cpn-obstructive lung disease associations remains to be established, reports of asthma improvement after treatment of Cpn infection deserve further investigation. Clinicians who manage asthma should be aware of this information since it may help to manage difficult cases. The hypothesis that Cpn infection in COPD can amplify smoking-associated inflammation and worsen fixed obstruction also deserves further study.
Acute Disease↗
Primary sensitization in infants.
OBJECTIVE: It has become increasingly clear that the mechanisms by which an allergic immune response is generated are complex and may begin even before a baby is born. Genetic, environmental, nutritional, and immunologic factors acting during pregnancy all play a role in determining whether or not a baby is born with a propensity to develop allergic sensitization and subsequent allergic disease. The objective of the research described in this article is to determine whether manipulation of any or all of these could lead to prevention of disease. DATA SOURCES: The database used was Medline up to and including 1997. The Conference Proceedings of the XVth World Congress of Asthmology in Montpellier 1996 are quoted. Many of the research hypotheses are generated from work performed in our own laboratories. STUDY SELECTION: The criteria used to select studies for review centered around a necessity for the data to have been collected in very early life with, if possible, a follow-up period to determine disease progression, or for the data to have been collected during pregnancy to elucidate primary mechanisms. RESULTS: It has been shown that a fetus is able to mount a proliferative response to a common allergic trigger (beta-lactoglobulin, house dust mite, etc) as early as 22 weeks of pregnancy. Maternal exposure to allergens influences her own IgG production which modulates the allergen exposure of the fetus resulting in either primary sensitization of T cells or "tolerance" to the allergen. Atopic mothers create a more Th2-orientated environment for the developing fetus than non-atopic mothers. CONCLUSIONS: Manipulation of the maternal immune response during pregnancy, either by altering her environment or controlling her allergic reactions, may be a method of preventing the development of allergic disease in infants.
Allergens↗
Facets of private practice nursing: a conceptual model.
AIM: This paper critically examines the literature relating to private practice nursing. Particular attention is given to the reasons nurses choose private practice and the major issues involved. A conceptual model has been developed based on this information. BACKGROUND: Nurses' roles are expanding into different work domains. Private practice nursing is one of the advanced practice options available. It also requires the nurse to develop business knowledge and skills. METHODS: A literature search was conducted of Pub-Med, Cinahl, Medline and InfoTrac databases using the terms 'private practice', 'nurse entrepreneur', 'nurses in business', Inurse practitioners', 'self-employed nurse', 'advanced practice' and 'clinical nurse specialist'. Further relevant articles were identified from the reference lists of papers detected by this literature search. In addition, conference proceedings were examined for any other material on this topic. FINDINGS: A thorough search of the existing literature revealed one unpublished theoretically based study which examined limited aspects of private practice nursing in Victoria. A reasonable number of articles and publications that provided anecdotal and personal accounts of being a nurse in business were identified. This review highlights the need for further theoretically based research in this area of nursing, so as to expand nursing knowledge. Suggestions are given for further research in this topical area. CONCLUSIONS/IMPLICATIONS: Existing research into private practice nursing is limited and not sufficient to inform changes to policy and nurse education. More research is needed.
Australia↗
A study of the references used in Cochrane protocols and reviews. Three bibles, three dictionaries, and nearly 25,000 other things.
OBJECTIVES: To describe the types of report that are cited by protocols and reviews included in the Cochrane Database of Systematic Reviews. METHODS: The citation for each reference included in the Cochrane protocols and reviews published in the Cochrane Database of Systematic Reviews in issue 1, 1999 of The Cochrane Library were categorized by reference type (e.g., journal article, conference proceeding, book chapter, personal communication, Cochrane review). RESULTS: Of a total of 24,913 citations, 21,694 (87.1%) were references to journal articles. There was a significant difference between the proportion of references to studies that were journal articles (12,348 of 13,472; 91.7%) and the proportion of other references in this category (9,346 of 11,441; 81.7%). CONCLUSION: The great majority of studies included in Cochrane reviews at the beginning of 1999 had been published as journal articles.
Clinical Protocols↗