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PubMed1999

Medical research in the Rhondda valleys.

This brief review has highlighted some of the research done by the MRC in the South Wales valleys. The two MRC Units published, in total, over 2000 reports ranging from letters to journals to conference proceedings, with around 200 reports appearing in the BMJ, Lancet and Nature alone. The expertise gained in South Wales meant that the Pneumoconiosis Research Unit team was involved internationally in co-ordinating research on coal workers' lung disease, and later on the health effects of asbestos and other respirable dusts. It is remarkable that the early large-scale studies were conducted and analysed without the benefits of modern computers and statistical packages. The varied Epidemiology Unit research programme enabled Cochrane to develop his ideas on defining health and evaluating health services, and also Elwood, who directed the Unit from 1974 to 1995, to pioneer studies of aspirin prophylaxis in cardiovascular disease. A steady stream of occupational health studies were carried out by Epidemiology Unit staff and many other large surveys were conducted in other parts of South Wales and across the country. Later MRC Epidemiology Unit work has focused on the town of Caerphilly where a prospective study of some 2500 men, established in 1979, has so far resulted in over 100 papers, notably on haemostatic factors related to heart disease. The study has run in tandem with a similar survey in the Speedwell area of Bristol which was established by former Epidemiology Unit staff working for the health authority in that area. Other medical research groups have also worked in the South Wales valleys. In 1961 Julian Tudor Hart left the Epidemiology Unit after a year's research to enter general practice, and establish the famous research practice at Glyncorrwg, over the mountain from the Rhondda Fawr. This year the extensive collection of MRC survey records is being transferred to the Department of Social Medicine at Bristol, and it is quite likely that further research will be undertaken relating Rhondda survey data collected over 40 years ago to subsequent mortality. The South Wales valleys will continue to contribute to medical research into the next millennium. Archie Cochrane's papers have been catalogued and are available for study at the Cochrane Archive established at Llandough Hospital.

Anemia↗
PubMed2005

Efficacy and effectiveness of physical therapy in enhancing postural control in children with cerebral palsy.

The purpose of this article was to conduct a systematic review of studies that examined the efficacy and effectiveness of postural control intervention strategies for children with CP. Only physical therapy interventions were included, e.g. adaptive seating devices, ankle foot orthoses, neurodevelopmental treatment. A multifaceted search strategy was employed to identify all potential studies published between 1990 and 2004. The search strategy included electronic databases, reference list scanning, author and citation tracking of relevant studies, and hand searching of pediatric physical therapy journals and conference proceedings. Twelve studies (1991-2004), comprising ten group design studies and two single subject studies, met our inclusion criteria. A variety of age ranges and severity of children with cerebral palsy (n=132) participated in the studies. The study quality scores ranged from 2 to 7 (total possible range of 0 to 7) with a median score of 5.5 and a mode of 6. As was true in an earlier systematic review on adaptive seating, most of the 12 'experimental' studies published since 1990 that were aimed at evaluating the effectiveness of postural control strategies provided lower levels of evidence, i.e. Sackett Levels III to V. Additional studies with stronger designs are needed to establish that postural control interventions for children with CP are effective.

Adult↗
PubMed2002

Respiratory failure.

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are common causes of hypoxemic respiratory failure. Multiple etiologies lead to direct and indirect pulmonary injury that progresses through an acute exudative phase, fibroproliferative phase, and recovery phase. Inflammatory mechanisms are thought to play a predominant role in the pathophysiology of ALI/ARDS. Mechanical ventilation with a lower tidal volume and an inspiratory plateau pressure of < or = 30 cm H2O is one intervention that has demonstrated a reduction in mortality. A clinical trial to determine the role of restrictive versus liberal fluid management is underway. Inhaled nitric oxide has been used to improve oxygenation but has not resulted in any outcome benefit. Glucocorticoids may be beneficial in the fibroproliferative phase of lung injury by suppressing chronic inflammation. Rigorous clinical trials of new and established interventions are required to determine optimum therapy and reduce mortality in ALI/ARDS.

Adult↗
PubMed2002

A review of plasma exchange in sepsis.

BACKGROUND: Severe sepsis involves a generalised inflammatory response, mediated by a number of cellular and humoral factors. Modulation of this response holds the promise of improved survival. Plasma exchange has been suggested as an adjunctive therapy in grave infective illnesses such as meningococcaemia, because it might remove harmful bacterial products and excessive endogenous inflammatory mediators. AIMS: The aim of this article is to outline plasma exchange as an adjunctive therapy in sepsis, with an emphasis on the available clinical and experimental evidence for its use. METHODS: A literature review was performed using Medline including all English language references to exchange transfusion, plasma exchange, plasmapheresis, plasma filtration and sepsis. Relevant texts and conference proceedings booklets were also hand searched. RESULTS: Uncontrolled human data from case reports of more than 40 patients treated with plasma exchange for severe sepsis suggest a survival rate of over 70%. Animal studies produced conflicting results depending on the species and the model of sepsis employed. The only controlled clinical trial was too small to make conclusions regarding mortality. CONCLUSIONS: Plasma exchange remains an intuitively attractive but unproven therapy in sepsis. More controlled clinical trials are needed.

Animals↗
PubMed2005

Diversity of gastric carcinogenesis.

Gastric cancer is still the second leading cause of cancer death worldwide, although the incidence of this disease has been gradually decreasing. The diversity of gastric cancer is well known. However, the mechanism underlying this diversity is still unknown. We have performed experimental and clinical studies on gastric carcinogenesis. These results suggest that the variety in the type and extent of inflammation in the stomach, and the different response to inflammation are responsible for the diversity in gastric carcinogenesis. This concept is supported by clinical and experimental evidence that eradication of Helicobacter pylori diminishes the incidence of gastric cancer and that PPAR gamma ligand, a modulator of inflammation and cell differentiation, prevents gastric carcinogenesis.

Animals↗
PubMed2006

A systematic review of treatments for electromagnetic hypersensitivity.

BACKGROUND: Electromagnetic hypersensitivity (EHS) is a poorly understood condition in which patients report symptoms following perceived exposure to weak electromagnetic fields (EMFs) such as those produced by mobile phones or visual display units. Little is known about the aetiology of the condition although experimental data suggest that EMFs are an unlikely causal agent. In this systematic review we assessed the efficacy of any treatment for people reporting EHS. METHODS: Twelve literature databases were examined to identify relevant studies. We also hand-searched conference proceedings and examined the reference sections of reviews and other papers. Only clinical trials that compared the efficacy of a potential treatment for EHS against a control condition were included in the review. RESULTS: Nine controlled clinical trials were identified, examining the effects of cognitive behavioural therapy (4 studies), visual display unit screen filters (2 studies), 'shielding' EMF emitters (1 study), supplementary antioxidant therapy (1 study) and acupuncture (1 study). The quality of these studies was limited. Nevertheless, their results suggest that cognitive behavioural therapy is more effective than providing no treatment. None of the other therapies have had their efficacy adequately demonstrated. CONCLUSIONS: The evidence base concerning treatment options for EHS is limited and more research is needed before any definitive clinical recommendations can be made. However, the best evidence currently available suggests that cognitive behavioural therapy is effective for patients who report being hypersensitive to weak EMFs.

Acupuncture Therapy↗
PubMed2004

A systematic review of the accuracy of ultrasound in the diagnosis of deep venous thrombosis in asymptomatic patients.

Evaluation of the accuracy of ultrasound has yielded heterogeneous results. Our objective was to summarize the evidence on the accuracy of ultrasound compared to venography in asymptomatic patients, taking into account the variation due to threshold differences. Searches of journal table of contents, computer databases (Medline, Embase, Biomed, Cochrane) and conference proceedings were performed. A study was eligible if it prospectively compared ultrasound to venography for the diagnosis of DVT in asymptomatic patients. Data of studies selected for inclusion were extracted independently by two authors. High quality studies with consecutive patient enrollment, blind evaluation of the two techniques, and absence of verification bias are summarized as Level 1, while those not fulfilling one or more of these criteria are considered Level 2. Original study authors were contacted to confirm accuracy and to provide missing data. A pooled estimate of the accuracy of ultrasound was obtained according to the method of Moses and coworkers. This method gives a summary diagnostic odds ratio (DOR). The DOR is a single indicator of test performance. It varies between 0 and infinity and exceeds 1, only when ultrasound is more often positive in patients with DVT relative to those without DVT. Higher DOR indicates better discriminatory test performance. Thirty one studies were rated as potentially unbiased and graded as Level 1. The mean prevalence of DVT as determined by venography was 22%. In Level 1 studies, the odds of positive ultrasound in proximal veins was 379 times higher (95% confidence limits 65, 2,200) and in distal veins 32 times higher (7.5, 135) among patients with DVT than those without. Our results suggest that, particularly for proximal veins, ultrasound is accurate for the diagnosis of DVT in asymptomatic postoperative orthopedic patients. More research is needed in other clinical settings.

Humans↗
PubMed2002

Interventions to improve medication adherence in schizophrenia.

OBJECTIVE: Although nonadherence with the antipsychotic medication regimen is a common barrier to the effective treatment for schizophrenia, knowledge is limited about how to improve medication adherence. This systematic literature review examined psychosocial interventions for improving medication adherence, focusing on promising initiatives, reasonable standards for conducting research in this area, and implications for clinical practice. METHOD: Studies were identified by computerized searches of MEDLINE and PsychLIT for the years between 1980 and 2000 and by manual searches of relevant bibliographies and conference proceedings. Key articles were summarized. RESULTS: Thirteen (33%) of 39 identified studies reported significant intervention effects. Although interventions and family therapy programs relying on psychoeducation were common in clinical practice, they were typically ineffective. Concrete problem solving or motivational techniques were common features of successful programs. Interventions targeted specifically to problems of nonadherence were more likely to be effective (55%) than were more broadly based treatment interventions (26%). One-half (four of eight) of the successful interventions not specifically focused on nonadherence involved an array of supportive and rehabilitative community-based services. CONCLUSIONS: Psychoeducational interventions without accompanying behavioral components and supportive services are not likely to be effective in improving medication adherence in schizophrenia. Models of community care such as assertive community treatment and interventions based on principles of motivational interviewing are promising. Providing patients with concrete instructions and problem-solving strategies, such as reminders, self-monitoring tools, cues, and reinforcements, is useful. Problems in adherence are recurring, and booster sessions are needed to reinforce and consolidate gains.

Antipsychotic Agents↗