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PubMed1996

Conservative management of mechanical neck disorders. A systematic overview and meta-analysis.

OBJECTIVE: This overview reports the efficacy of conservative treatments (drug therapy, manual therapy, patient education, physical medicine modalities) in reducing pain in adults with mechanical neck disorders. METHODS: Computerized bibliographic database searches from 1985 to December 1993, information requests from authors, and bibliography screenings were used to identify published and unpublished research. Applying strict criteria, two investigators independently reviewed the blinded articles. Each selected trial was evaluated independently for methodologic quality. RESULTS: Twenty-four randomized controlled trials (RCTs) and eight before-after studies met our selection criteria. Twenty RCTs rated moderately strong or better in terms of methodologic quality. Five trials using manual therapy in combination with other treatments were clinically similar, were statistically not heterogeneous (p = 0.98), and were combined to yield an effect size of -0.6 (95% CI: -0.9, -0.4), equivalent to a 16 point improvement on a 100 point pain scale. Four RCTs using physical medicine modalities were combined using the inverse chi-square method: two using electromagnetic therapy produced a significant reduction in pain (p < 0.01); and two using laser therapy did not differ significantly from a placebo (p = 0.63). Little or no scientific evidence exists for other therapies, including such commonly used treatments as medication, rest and exercise. CONCLUSIONS: Within the limits of methodologic quality, the best available evidence supports the use of manual therapies in combination with other treatments for short-term relief of neck pain. There is some support for the use of electromagnetic therapy and against the use of laser therapy. In general, other interventions have not been studied in enough detail adequately to assess efficacy or effectiveness. This overview provides the foundation for an evidence-based approach to practice. More robust design and methodology should be used in future research, in particular, the use of valid and reliable outcomes measures.

Acupuncture Therapy↗

PubMed1997

Clinical trials of interactive computerized patient education: implications for family practice.

A systematic review of randomized clinical trials was conducted to evaluate the acceptability and usefulness of computerized patient education interventions. The Columbia Registry, MEDLINE, Health, BIOSIS, and CINAHL bibliographic databases were searched. Selection was based on the following criteria: (1) randomized controlled clinical trials, (2) educational patient-computer interaction, and (3) effect measured on the process or outcome of care. Twenty-two studies met the selection criteria. Of these, 13 (59%) used instructional programs for educational intervention. Five studies (22.7%) tested information support networks, and four (18%) evaluated systems for health assessment and history-taking. The most frequently targeted clinical application area was diabetes mellitus (n = 7). All studies, except one on the treatment of alcoholism, reported positive results for interactive educational intervention. All diabetes education studies, in particular, reported decreased blood glucose levels among patients exposed to this intervention. Computerized educational interventions can lead to improved health status in several major areas of care, and appear not to be a substitute for, but a valuable supplement to, face-to-face time with physicians.

Adolescent↗

PubMed1998

[The database server for the medical bibliography database at Charles University].

In the medical community, bibliographic databases are widely accepted as a most important source of information both for theoretical and clinical disciplines. To improve access to medical bibliographic databases at Charles University, a database server (ERL by Silver Platter) was set up at the 2nd Faculty of Medicine in Prague. The server, accessible by Internet 24 hours/7 days, hosts now 14 years' MEDLINE and 10 years' EMBASE Paediatrics. Two different strategies are available for connecting to the server: a specialized client program that communicates over the Internet (suitable for professional searching) and a web-based access that requires no specialized software (except the WWW browser) on the client side. The server is now offered to academic community to host further databases, possibly subscribed by consortia whose individual members would not subscribe them by themselves.

Czech Republic↗

PubMed1991

OLIO+: an osteopathic medicine database.

OLIO+ is a bibliographic database designed to meet the information needs of the osteopathic medical community. Produced by the American Osteopathic Association (AOA), OLIO+ is devoted exclusively to the osteopathic literature. The database is available only by subscription through AOA and may be accessed from any data terminal with modem or IBM-compatible personal computer with telecommunications software that can emulate VT100 or VT220. Apple access is also available, but some assistance from OLIO+ support staff may be necessary to modify the Apple keyboard.

Data Display↗

PubMed1996

The project ARIANE: conceptual queries to information databases.

As information databases we consider all the collections of data records indexed by key-words, stored and delivered by computer systems. In previous research works we demonstrated the interest to design a conceptual model, in the conceptual graphs formalism, and to implement a computational model for information retrieval in large information databases. These models are based on the UMLS knowledge sources. This paper reminds briefly these models and describes tests done in querying a patients database and a bibliographical database.

Databases, Bibliographic↗

PubMed1991

Using OMIM (On-line Mendelian Inheritance in Man) as an expert system in medical genetics.

Expert systems have been used in Medicine for many years, but they are usually highly sophisticated and not well integrated into day-to-day practice. On the other hand, bibliographic databases such as Medline and others are easily accessible and are widely used. We report here the use of OMIM (On-line Mendelian Inheritance in Man), one of these bibliographic databases, as an expert system in Medical Genetics. The description of 93 syndromes was used as search-key and the diagnoses proposed by OMIM were analyzed to determine whether the correct diagnosis was among them. The proposed diagnoses were automatically ranked by OMIM from the most probable (weight = 100) to the least probable (weight = 1). OMIM suggested a total of 1538 +/- 692.2 diagnoses per search. In order to deal with a reasonable number of proposed diagnoses, we only considered the diagnoses with a weight of 50 or more. With this limit, OMIM proposed a mean of 37.0 +/- 24.6 diagnoses per case. The overall accuracy was 76%. A correct answer with a perfect weight of 100 was proposed in 29% of the case. The diagnostic accuracy of OMIM increased linearly when weights lower than 100 were considered. When the rank alone was analyzed, the accuracy of OMIM increased very rapidly from position 1 to 5 with a subsequent almost linear increase. If one only considered the first five proposed diagnoses, the accuracy of OMIM was just above 50%. This study shows that bibliographic databases are not only restricted to the provision of references but could also be used as expert systems and are therefore of great value to medical geneticists.

Databases, Bibliographic↗

PubMedDate not supplied

[Characteristics of 107 Spanish healthcare registries and evaluation of the utilization thereof].

BACKGROUND: The information concerning the currently existing healthcare registries in our country is not readily accessible, is scarce and some are not well-known, possibly being underused in comparison to their many potential uses. This study is aimed at evaluating the characteristics of the Spanish Healthcare registries and the utilization thereof, especially in Healthcare technology assessment. METHODS: Descriptive, cross-sectional study of the Spanish Healthcare registries within the 1997-2002 period. These registries were identified by means ofa bibliographic databases search and by way of a survey of Scientific Societies and Central and Autonomic Healthcare Administration. Another bibliographic databases search was conducted of the publications which use data from the healthcare registries included and have been evaluated by applying the scientific evidence quality criteria. RESULTS: A total of 107 healthcare registries were identified, most of which of local or regional coverage (71%), preferably were under Autonomic government authority (64.5%). The areas showing the largest number of registries identified were those related to death statistics (16.8%) and cancer (15.9%). A total of 298 publications were retrieved which analyze data produced by the registries identified, most of which are devoted to the study of the frequency and distribution of the events recorded (58.1%) and less frequently to the conducting of healthcare technology assessment studies (24.4%). CONCLUSIONS: The critical evaluation of the publications made it possible to identify some elements related to the analysis methodology and design which would heighten the quality of the healthcare technology assessment. Healthcare registries in Spain have developed recently and to differing degrees. Important areas without any records and improvement elements related to the use of healthcare registries for healthcare technology assessment were detected. It would be advisable to avail of a register of registries which would provide relevant, up-dated information thereon.

Cross-Sectional Studies↗

PubMed2003

Editorial board of the Russian journal of immunology: the 2003 update.

The year 2002 has been, probably, the most complicated and eventful in the short history of the RJI. During that year many projects planned by the Editorial Board in the beginning-middle of the year 2001 started to become a reality. Unfortunately, one of the main initiators of these projects - Editor-in-Chief of the RJI, Professor Anatoly N. Cheredeev - cannot witness this success. On May 3rd, 2003 it will be a year since A.N. Cheredeev died. One of the important projects that we have accomplished is the creation of a joint Internet site of the RSI and the RJI that provides online access to the full text of articles of the journal. Although this «Russian Immunology» site (www.rji.ru) still needs a lot of work, it already takes a noteworthy place among other immunology resources on the Internet. The number of visitors of this site increased in four times during 2002, reaching more than 1500 users a month. A second important project accomplished during the past year has been the inclusion of the RJI to the biggest international bibliographic databases. At the beginning of 2002 the RJI was added to the list of indexed and cited journals of the oldest database - the Chemical Abstracts. In addition, we are glad to announce that the complete archive of articles published in the RJI has just been added to the most popular and visited bibliographic database, the Index Medicus/Medline/PubMed. Following the tradition every two years the RJI makes changes in the Editorial Board. The reasons for these changes are the advances in the field of Immunology, the establishment of new research directions, the opening of new laboratories, and the appearance of new scientific leaders. The incorporation of these new leaders into the Editorial Board improves the journal productivity, making the review process more effective and attracting new interesting authors. We would like to introduce the new members of our Editorial Board.

Databases, Bibliographic↗

PubMed1999

Searching the right database. A comparison of four databases for psychiatry journals.

Journal coverage is one factor that affects the retrieval of relevant information from bibliographic databases. The aims of this study were to investigate the coverage of databases for psychiatry journals, and to assess the overlap between databases. Psychiatry journals were identified using Ulrich's International Periodicals Directory and then analysed to see which bibliographic databases indexed the most journals. A total of 213 abstracting and indexing services were listed as indexing at least one of the 977 psychiatry journals identified. The four most frequently cited databases (PSYCLIT, EMBASE, BIOSIS and MEDLINE) indexed 506 (52%) of the psychiatry journals. Of these 506 journals, PSYCLIT indexed 367 (73%), EMBASE 337 (67%), BIOSIS 243 (48%) and MEDLINE 236 (47%). Combining the databases with the highest yields (PSYCLIT and EMBASE) increased the number of journals indexed to 461 (91%). The four databases combined accounted for 90% of all psychiatry journals found to be indexed by at least one abstracting and indexing service. More than 400 journals were not indexed at all. Variations in the overlap between PSYCLIT, EMBASE, BIOSIS and MEDLINE, and the high proportion (35%) of journals indexed in only one of these four databases emphasize the importance of searching more than one or even two databases to ensure optimal coverage of the literature.

Abstracting and Indexing↗

PubMed2006

Mapping the literature of nurse practitioners.

OBJECTIVES: This study was designed to identify core journals for the nurse practitioner specialty and to determine the extent of their indexing in bibliographic databases. METHODS: As part of a larger project for mapping the literature of nursing, this study followed a common methodology based on citation analysis. Four journals designated by nurse practitioners as sources for their practice information were selected. All cited references were analyzed to determine format types and publication years. Bradford's Law of Scattering was applied to identify core journals. Nine bibliographic databases were searched to estimate the index coverage of the core titles. RESULTS: The findings indicate that nurse practitioners rely primarily on journals (72.0%) followed by books (20.4%) for their professional knowledge. The majority of the identified core journals belong to non-nursing disciplines. This is reflected in the indexing coverage results: PubMed/MEDLINE more comprehensively indexes the core titles than CINAHL does. CONCLUSION: Nurse practitioners, as primary care providers, consult medical as well as nursing sources for their information. The implications of the citation analysis findings are significant for collection development librarians and indexing services.

Abstracting and Indexing↗

PubMed2005

[Possibilities of governmental quality support of scientific journals in Croatia].

The measure of success for a scientific journal, which publishes original research, is its visibility in the international scientific community. The most comprehensive bibliographical database of the Institute for Scientific Information (ISI, now Thomson ISI), Web of Science, indexes 13 out of 176 journals that received financial support from the Ministry of Science in 2003, and 7 of them are in the 9 divisions of the most selective ISI bibliographic database, Current Contents. Taking into account the specificities of the small scientific community, or the so-called scientific "periphery" to which Croatia belongs, we proposed a new system of financial support of scientific journals in Croatia. Such system would support all scientific journals fulfilling basic requirements of scholarly publishing, such as structure of the editorial board and office, editorial procedures and records. Indexing in professional and general bibliographic databases would be encouraged by additional financial support and continual control of the editorial work in the journals.

Croatia↗

PubMed1997

Locating and appraising systematic reviews.

Several methods can be used to identify systematic reviews. These include bibliographic databases, such as MEDLINE, Best Evidence, and the Cochrane Library. In the future, the Cochrane Library could become the source of choice for systematic reviews because it provides the full text for Cochrane reviews and citations to many other systematic reviews. Moreover, the Library is growing rapidly and becoming more readily available, and its searching capabilities are being improved with each update. Although Best Evidence contains fewer systematic reviews than the Cochrane Library, it is specifically designed for practicing internists and primary care physicians and includes systematic reviews on diagnosis, cause, prognosis, and quality improvement. At present, however, MEDLINE and other bibliographic databases are probably the most up-to-date and readily available sources of systematic reviews. Systematic reviews are a powerful and useful way to assemble evidence; however, just because a review has been done using systematic review methods does not guarantee that its results are credible. Regardless of the source, all systematic reviews (like all types of research evidence) require critical appraisal to determine their validity and to establish whether and how they will be useful in practice.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2004

Finding qualitative research: an evaluation of search strategies.

BACKGROUND: Qualitative research makes an important contribution to our understanding of health and healthcare. However, qualitative evidence can be difficult to search for and identify, and the effectiveness of different types of search strategies is unknown. METHODS: Three search strategies for qualitative research in the example area of support for breast-feeding were evaluated using six electronic bibliographic databases. The strategies were based on using thesaurus terms, free-text terms and broad-based terms. These strategies were combined with recognised search terms for support for breast-feeding previously used in a Cochrane review. For each strategy, we evaluated the recall (potentially relevant records found) and precision (actually relevant records found). RESULTS: A total yield of 7420 potentially relevant records was retrieved by the three strategies combined. Of these, 262 were judged relevant. Using one strategy alone would miss relevant records. The broad-based strategy had the highest recall and the thesaurus strategy the highest precision. Precision was generally poor: 96% of records initially identified as potentially relevant were deemed irrelevant. Searching for qualitative research involves trade-offs between recall and precision. CONCLUSIONS: These findings confirm that strategies that attempt to maximise the number of potentially relevant records found are likely to result in a large number of false positives. The findings also suggest that a range of search terms is required to optimise searching for qualitative evidence. This underlines the problems of current methods for indexing qualitative research in bibliographic databases and indicates where improvements need to be made.

Breast Feeding↗

PubMed2000

Corticosteroids for maintaining remission of Crohn's disease.

OBJECTIVES: To evaluate the effectiveness and safety of conventional systemic corticosteroid therapy in maintaining clinical remission in Crohn's disease. SEARCH STRATEGY: A computer-assisted search of the on-line bibliographic database MEDLINE of studies published in English, French, Spanish, Italian and German between 1966 and May, 1998. Manual searches of the reference lists from the potentially relevant studies were performed in order to identify additional studies that may have been missed using the computer-assisted search strategy. Proceedings from major gastrointestinal meetings were also manually searched from 1985 to 1997 in order to identify unpublished studies. The Cochrane Controlled Trials Register and the Inflammatory Bowel Disease Review Group Trials Register were also searched. SELECTION CRITERIA: Randomized double-blind placebo-controlled trials involving patients of any age with Crohn's disease in clinical remission as defined by a CDAI < 150 or by the presence of no symptoms or only mild symptoms at the time of entry into the trial. The experimental treatment consisted of oral conventional corticosteroid therapy (excluding budesonide, fluticasone, etc). Clinical disease relapse was used as the outcome measure of interest. DATA COLLECTION AND ANALYSIS: Eligible studies were selected by 4 reviewers and data were extracted onto standardized data extraction forms. Disagreements in eligibility or data extraction were resolved by consensus. Data were converted into individual 2x2 tables for each study. The presence of significant heterogeneity among studies was tested using the chi-square test. The 2x2 tables were synthesized into a summary test statistic using the pooled odds ratio and 95% confidence intervals as described by Cochran and Mantel and Haenszel (the 'odds ratio' in MetaView). A fixed effects model was used for the pooling of data. MAIN RESULTS: Four studies were initially judged as being eligible for inclusion. After obtaining additional information on one of the studies it was excluded because it was not double-blind. The total number of subjects included in the analysis at the time points of 6, 12 and 24 months were 142, 131 and 95 for the corticosteroid group and 161, 138 and 87 for the control group. The odds ratios for relapse on active treatment and the corresponding 95% confidence intervals were 0.71 (0.39, 1.31), 0.82 (0.47, 1.43) and 0.72 (0.38, 1.35) at 6, 12 and 24 months. The numbers needed to treat with corticosteroids to prevent one additional relapse were 24, 35, 15 respectively. REVIEWER'S CONCLUSIONS: The use of conventional systemic corticosteroids in patients with clinically quiescent Crohn's disease does not appear to reduce the risk of relapse over a 24 month period of follow-up.

Adrenal Cortex Hormones↗

PubMed1996

Implementation of a reference management system, MacRefer, under HyperCard.

We have developed a reference management system, MacRefer, using HyperTalk on Macintosh personal computers. Using this program, one can automatically acquire data from databases created by EndNote Plus and from OVID- or Medlar-formatted records downloaded via an online use of Medline. The MacRefer's capability of formatting bibliographic database in user-defined formats is comparable with the exemplified bibliography maker, EndNote Plus. Moreover, MacRefer has several competitive features, which are insufficiently equipped with EndNote Plus. For example, MacRefer is capable of (1) maintaining subsets within a database, (2) executing complex, structured searches combining up to nine keywords for any data field with the results and search conditions preserved, and (3) easily browsing (a portion of) reference database. Although MacRefer cannot be recognized as an absolute alternative of EndNote Plus because of several limitations inherent to HyperCard, the compensatory use of these two programs will expand the personal utilization of bibliographic databases.

Computers↗

PubMed2000

Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer.

BACKGROUND: Intestinal obstruction commonly occurs in progressive advanced gynaecological and gastrointestinal cancers. Management of these patients is difficult due to the patients deteriorating mobility and function (performance status), the lack of further chemotherapeutic options and the high mortality and morbidity associated with palliative surgery. There are marked variations in clinical practice concerning surgery in these patients between different countries, gynaecological oncology units, and general hospitals as well as referral patterns from oncologists under whom these patients are often admitted under. There is therefore a need for all the present information to be collated, analysed (with appropriate palliative care outcomes) to establish if surgery is of benefit and what further research is needed. OBJECTIVES: The objective was to locate, appraise and summarise evidence from scientific studies on intestinal obstruction due to advanced gynaecological and gastrointestinal cancer, in order to assess the efficacy of surgery. SEARCH STRATEGY: A comprehensive list of studies was provided by an extensive search of electronic databases, relevant journals, bibliographic databases, conference proceedings, reference lists, the grey literature, personal contact and the world wide web. SELECTION CRITERIA: As the review concentrates on the 'best evidence' available of the role of surgery in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer the inclusion criteria were kept broad (included both prospective and retrospective studies) so as to include all studies relevant to the question. DATA COLLECTION AND ANALYSIS: Data extraction forms were used to collect data from the studies included in the review. Two researchers extracted the data independently to reduce error. Due to the methodological quality of the studies, only a qualitative assessment was possible. MAIN RESULTS: The role of surgery in malignant bowel obstruction remains controversial, and no firm conclusions from the many retrospective case series can be made. Control of symptoms varies from 42% to over 80%, though it is often unclear how symptoms were measured and whether the tools used to collect symptom scores are validated. There is a large range in the rates of re-obstruction, from 10-50%, though time to re-obstruction was often not included. There is a wide range of postoperative morbidity and mortality, although again the definition of both these surgical outcomes varied between many of the papers. REVIEWER'S CONCLUSIONS: The role of surgery in malignant bowel obstruction needs careful evaluation, using validated outcome measures of symptom control and quality of life scores. Further information would include re-obstruction rates together with the morbidity associated with the various surgical procedures. Currently, bowel obstruction is managed empirically, and there are marked variations in clinical practice by different units. There needs to be a greater standardisation of management so that comparisons between different series can be made.

Female↗

PubMed1999

Systematic review of surgery in malignant bowel obstruction in advanced gynecological and gastrointestinal cancer. The Systematic Review Steering Committee.

OBJECTIVE: The objective was to locate, appraise, and summarize evidence from scientific studies on intestinal obstruction due to advanced gynecological and gastrointestinal cancer in order to assess the efficacy of surgery. MATERIALS AND METHODS DATA SOURCES: A comprehensive list of studies was provided by an extensive search of electronic databases, relevant journals, bibliographic databases, conference proceedings, reference lists, the gray literature, personal contact, and the worldwide web. DATA SYNTHESIS: Two researchers extracted the data independently. Due to the methodological quality of the studies, only a qualitative assessment was possible. RESULTS: The role of surgery in malignant bowel obstruction remains controversial, and no firm conclusions from the many retrospective case series can be made. Control of symptoms varies from 42% to over 80%, although it is often unclear how symptoms were measured and whether the symptom scores used are validated. There is a large range in the rates of reobstruction, from 10 to 50%, although time to reobstruction was often not included. There is a wide range of postoperative morbidity and mortality, although again the definition of both of these surgical outcomes varied among many of the papers. CONCLUSION: The role of surgery in malignant bowel obstruction needs careful evaluation, using validated outcome measures on symptom control and quality of life scores. Further information would include reobstruction rates together with the morbidity associated with the various surgical procedures. Currently, bowel obstruction is managed empirically, and there are marked variations in clinical practice by different units. There needs to be a greater standardization of management so that comparisons between different series can be made.

Female↗

PubMed1999

Systematic review and meta-analysis of corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancers. Systematic Review Steering Committee.

BACKGROUND: The objective was to locate, appraise and summarise evidence from scientific studies on intestinal obstruction due to advanced gynaecological and gastrointestinal cancers, in order to assess the efficacy of corticosteroids. MATERIALS AND METHODS. DATA SOURCES: A comprehensive list of studies was provided by an extensive search of electronic databases, relevant journals, bibliographic databases, conference proceedings, reference lists, the grey literature, personal contact and the world wide web. DATA SYNTHESIS: Two researchers extracted the data independently. A qualitative analysis was performed of the dichotomous data of resolution of obstruction and death at one month. Both fixed and random effect models were used. Number needed to treat (with corticosteroids to resolve one episode of bowel obstruction) was derived from the odds ratio. Kaplan-Meier survival curves from individual patient data were also analysed. Studies of lower methodological quality were assessed in a qualitative manner. RESULTS: There is a trend towards resolution of bowel obstruction using corticosteroids but this result does not achieve statistical significance. There is no statistically significant difference in mortality at one month, nor in the Kaplan Meier survival curves. Number needed to treat is 6, though with wide confidence intervals (3-infinity). The results are robust to fixed and random effects models and to 'best' and 'worst case' scenarios on the data from missing patients. The morbidity associated with corticosteroids appears to be very low. CONCLUSIONS: The role of corticosteroids needs further elucidation. More patients need to be recruited in order to obtain more precise results. Further trials should include quality of life measures as primary outcomes as well as most effective type of corticosteroid, dose or dosing regime, route of administration and morbidity.

Adrenal Cortex Hormones↗