Systematic Review (systematic + review)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Systematic Review

  • cochrane systematic review
  • comprehensive systematic review
  • methods systematic review
  • previous systematic review
  • qualitative systematic review
  • recent systematic review

  • Terms modified by Systematic Review

  • systematic review process

  • Selected Abstracts


    INTERVENTIONS FOR PREVENTING FALLS IN ACUTE AND CHRONIC CARE HOSPITALS: A SYSTEMATIC REVIEW AND META-ANALYSIS

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2008
    Niloufar Hadidi APRN
    No abstract is available for this article. [source]


    LAPAROSCOPIC HEPATECTOMY, A SYSTEMATIC REVIEW

    ANZ JOURNAL OF SURGERY, Issue 11 2007
    Jerome M. Laurence
    This systematic review was undertaken to assess the published evidence for the safety, feasibility and reproducibility of laparoscopic liver resection. A computerized search of the Medline and Embase databases identified 28 non-duplicated studies including 703 patients in whom laparoscopic hepatectomy was attempted. Pooled data were examined for information on the patients, lesions, complications and outcome. The most common procedures were wedge resection (35.1%), segmentectomy (21.7%) and left lateral segmentectomy (20.9%). Formal right hepatectomy constituted less than 4% of the reported resections. The conversion and complication rates were 8.1% and 17.6%, respectively. The mortality rate over all these studies was 0.8% and the median (range) hospital stay 7.8 days (2,15.3 days). Eight case,control studies were analysed and although some identified significant reductions in-hospital stay, time to first ambulation after surgery and blood loss, none showed a reduction in complication or mortality rate for laparoscopically carried out resections. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by appropriately skilled surgeons. Further work is needed to determine whether these conclusions can be generalized to include formal right hepatectomy. [source]


    RAPID VERSUS FULL SYSTEMATIC REVIEWS: VALIDITY IN CLINICAL PRACTICE?

    ANZ JOURNAL OF SURGERY, Issue 11 2008
    Amber Watt
    Introduction: Rapid reviews are being produced with greater frequency by health technology assessment (HTA) agencies in response to increased pressure from end-user clinicians and policy-makers for rapid, evidence-based advice on health-care technologies. This comparative study examines the differences in methodologies and essential conclusions between rapid and full reviews on the same topic, with the aim of determining the validity of rapid reviews in the clinical context and making recommendations for their future application. Methods: Rapid reviews were located by Internet searching of international HTA agency websites, with any ambiguities resolved by further communication with the agencies. Comparator full systematic reviews were identified using the University of York Centre for Reviews and Dissemination HTA database. Data on a number of review components were extracted using standardized data extraction tables, then analysed and reported narratively. Results: Axiomatic differences between all the rapid and full reviews were identified; however, the essential conclusions of the rapid and full reviews did not differ extensively across the topics. For each of the four topics examined, it was clear that the scope of the rapid reviews was substantially narrower than that of full reviews. The methodology underpinning the rapid reviews was often inadequately described. Conclusions: Rapid reviews do not adhere to any single validated methodology. They frequently provide adequate advice on which to base clinical and policy decisions; however, their scope is limited, which may compromise their appropriateness for evaluating technologies in certain circumstances. [source]


    Guidelines for Systematic Review in Conservation and Environmental Management

    CONSERVATION BIOLOGY, Issue 6 2006
    ANDREW S. PULLIN
    política de la conservación; práctica de la conservación; toma de decisiones; transferencia de conocimiento basado en evidencia Abstract:,An increasing number of applied disciplines are utilizing evidence-based frameworks to review and disseminate the effectiveness of management and policy interventions. The rationale is that increased accessibility of the best available evidence will provide a more efficient and less biased platform for decision making. We argue that there are significant benefits for conservation in using such a framework, but the scientific community needs to undertake and disseminate more systematic reviews before the full benefit can be realized. We devised a set of guidelines for undertaking formalized systematic review, based on a health services model. The guideline stages include planning and conducting a review, including protocol formation, search strategy, data inclusion, data extraction, and analysis. Review dissemination is addressed in terms of current developments and future plans for a Web-based open-access library. By the use of case studies we highlight critical modifications to guidelines for protocol formulation, data-quality assessment, data extraction, and data synthesis for conservation and environmental management. Ecological data presented significant but soluble challenges for the systematic review process, particularly in terms of the quantity, accessibility, and diverse quality of available data. In the field of conservation and environmental management there needs to be further engagement of scientists and practitioners to develop and take ownership of an evidence-based framework. Resumen:,Un mayor número de disciplinas está utilizando marcos de referencia basados en evidencias para revisar y diseminar la efectividad de las intervenciones de gestión y política. El fundamento es que la mayor accesibilidad de la evidencia mejor disponible proporcionará una plataforma de toma de decisiones menos sesgada y más eficiente. Argumentamos que hay beneficios significativos para la conservación al utilizar tal marco de referencia, pero la comunidad científica debe emprender y diseminar revisiones más sistemáticas antes de que se pueda comprender el beneficio completo. Diseñamos un conjunto de directrices para realizar revisiones sistemáticas formales, basado en un modelo de servicios de salud. Las etapas de las directrices incluyen la planificación y conducción de una revisión, incluyendo formación del protocolo, estrategias de búsqueda, inclusión de datos, extracción y análisis de datos. La diseminación de revisiones es abordada en términos del desarrollo actual y los planes futuros para una biblioteca de acceso abierto en la Web. Al utilizar estudios de caso resaltamos modificaciones críticas a las directrices para la formulación del protocolo, evaluación de la calidad de los datos, extracción de datos y síntesis de datos para la gestión ambiental y de conservación. Los datos ecológicos presentaron retos significativos, pero solucionables, para el proceso de revisión sistemática, particularmente en términos de la cantidad, accesibilidad y calidad de los datos disponibles. Se requiere un mayor compromiso de científicos y profesionales de la gestión ambiental y de conservación para desarrollar y apropiarse de un marco de referencia basado en evidencias. [source]


    Surgical Monotherapy Versus Surgery Plus Adjuvant Radiotherapy in High-Risk Cutaneous Squamous Cell Carcinoma: A Systematic Review of Outcomes

    DERMATOLOGIC SURGERY, Issue 4 2009
    ANOKHI Jambusaria-PAHLAJANI MD
    BACKGROUND Adjuvant radiotherapy (ART) has been recommended for squamous cell carcinoma (SCC) with a high risk of recurrence, particularly perineurally invasive disease. The utility of ART is unknown. This study compares reported outcomes of high-risk SCC treated with surgical monotherapy (SM) with those of surgery plus ART (S+ART). METHODS The Medline database was searched for reports of high-risk SCC treated with SM or S+ART that reported outcomes of interest: local recurrence, regional or distant metastasis, or disease-specific death. RESULTS There were no controlled trials. Of the 2,449 cases of high-risk SCC included, 91 were treated with S+ART. Tumor stage and surgical margin status before ART were generally unreported. In 74 cases of perineural invasion (PNI), outcomes were statistically similar between SM and S+ART. In 943 high-risk SCC cases in which clear surgical margins were explicitly documented, risks of local recurrence, regional metastasis, distant metastasis, and disease-specific death were 5%, 5%, 1%, and 1%, respectively. CONCLUSIONS High cure rates are achieved in high-risk cutaneous SCC when clear surgical margins are obtained. Current data are insufficient to identify high-risk features in which ART may be beneficial. In cases of PNI, the extent of nerve involvement appears to affect outcomes, with involvement of larger nerves imparting a worse prognosis. [source]


    Sentinel Lymph Node Biopsy in Cutaneous Squamous Cell Carcinoma: A Systematic Review of the English Literature

    DERMATOLOGIC SURGERY, Issue 11 2006
    AMY SIMON ROSS MD
    BACKGROUND Although most cutaneous squamous cell carcinoma (SCC) is curable by a variety of treatment modalities, a small subset of tumors recur, metastasize, and result in death. Although risk factors for metastasis have been described, there are little data available on appropriate workup and staging of patients with high-risk SCC. OBJECTIVE We reviewed reported cases and case series of SCC in which sentinel lymph node biopsy (SLNB) was performed to determine whether further research is warranted in developing SLNB as a staging tool for patients with high-risk SCC. METHODS The English medical literature was reviewed for reports of SLNB in patients with cutaneous SCC. Data from anogenital and nonanogenital cases were collected and analyzed separately. The percentage of cases with a positive sentinel lymph node (SLN) was calculated. False negative and nondetection rates were tabulated. Rates of local recurrence, nodal and distant metastasis, and disease-specific death were reported. RESULTS A total of 607 patients with anogenital SCC and 85 patients with nonanogenital SCC were included in the analysis. A SLN could not be identified in 3% of anogenital and 4% of nonanogenital cases. SLNB was positive in 24% of anogenital and 21% of nonanogenital patients. False-negative rates as determined by completion lymphadenectomy were 4% (8/213) and 5% (1/20), respectively. Most false-negative results were reported in studies from 2000 or earlier in which the combination of radioisotope and blue dye was not used in the SLN localization process. Complications were reported rarely and were limited to hematoma, seroma, cutaneous lymphatic fistula, wound infection, and dehiscence. CONCLUSIONS Owing to the lack of controlled studies, it is premature to draw conclusions regarding the utility of SLNB in SCC. The available data, however, suggest that SLNB accurately diagnoses subclinical lymph node metastasis with few false-negative results and low morbidity. Controlled studies are needed to demonstrate whether early detection of subclinical nodal metastasis will lead to improved disease-free or overall survival for patients with high-risk SCC. [source]


    Effectiveness of Corticosteroid Treatment in Acute Pharyngitis: A Systematic Review of the Literature

    ACADEMIC EMERGENCY MEDICINE, Issue 5 2010
    Andrew Wing
    Abstract Objectives:, The objective was to examine the effectiveness of corticosteroid treatment for the relief of pain associated with acute pharyngitis potentially caused by group A beta-hemolytic Streptococcus (GABHS). Methods:, This was a systematic review of the literature. Data sources used were electronic databases (Cochrane Library, MEDLINE, EMBASE, Biosis Previews, Scopus, and Web of Science), controlled trial registration websites, conference proceedings, study references, experts in the field, and correspondence with authors. Selection criteria consisted of randomized controlled trials (RCTs) in which corticosteroids, alone or in combination with antibiotics, were compared to placebo or any other standard therapy for treatment of acute pharyngitis in adult patients, pediatric patients, or both. Two reviewers independently assessed for relevance, inclusion, and study quality. Weighted mean differences (WMDs) were calculated and are reported with corresponding 95% confidence intervals (CIs). Results:, From 272 potentially relevant citations, 10 studies met the inclusion criteria. When compared to placebo, corticosteroids reduced the time to clinically meaningful pain relief (WMD = ,4.54 hours; 95% CI = ,7.19 to ,1.89); however, they provided only a small reduction in pain scores at 24 hours (WMD = ,0.90 on a 0,10 visual analog scale; 95% CI = ,1.5 to ,0.3). Heterogeneity among pooled studies was identified for both outcomes (I2 = 81 and 74%, respectively); however, the GABHS-positive subgroup receiving corticosteroid treatment did have a significant mean reduction in time to clinically meaningful pain relief of 5.22 hours (95% CI = ,7.02 to ,3.42; I2 = 0%). Short-term side effect profiles between corticosteroids and placebo groups were similar. Conclusions:, Corticosteroid administration for acute pharyngitis was associated with a relatively small effect in time to clinically meaningful pain relief (4.5-hour reduction) and in pain relief at 24 hours (0.9-point reduction), with significant heterogeneity in the pooled results. Decision-making should be individualized to determine the risks and benefits; however, corticosteroids should not be used as routine treatment for acute pharyngitis. ACADEMIC EMERGENCY MEDICINE 2010; 17:476,483 © 2010 by the Society for Academic Emergency Medicine [source]


    Systematic Review and Meta-analysis of Incidence Studies of Epilepsy and Unprovoked Seizures

    EPILEPSIA, Issue 11 2002
    Irene A. W. Kotsopoulos
    Summary: ,Purpose: To evaluate the methodology of incidence studies of epilepsy and unprovoked seizures and to assess the value of their findings by summarizing their results. Methods: A Medline literature search from January 1966 to December 1999 was conducted. In each selected study, key methodologic items such as case definition and study design were evaluated. Furthermore, a quantitative meta-analysis of the incidence data was performed. Results: Forty incidence studies met the inclusion criteria. There was considerable heterogeneity in study methodology, and the methodologic quality score was generally low. The median incidence rate of epilepsy and unprovoked seizures was 47.4 and 56 per 100,000, respectively. The age-specific incidence of epilepsy was high in those aged 60 years or older, but was highest in childhood. Males had a slightly higher incidence of epilepsy (median, 50.7/100,000) than did females (median, 46.2/100,000), and partial seizures seemed to occur more often than generalized seizures. Developing countries had a higher incidence rate of epilepsy (median, 68.7/100,000) than did industrialized countries (median, 43.4/100,000). Similar results were found for unprovoked seizures. The incidence of epilepsy over time appears to decrease in children, whereas it increases in the elderly. Conclusions: The age-specific incidence of epilepsy showed a bimodal distribution with the highest peak in childhood. No definitive conclusions could be reached for the incidence of unprovoked seizures and other specific incidence rates of epilepsy. More incidence studies with an adequate study methodology are needed to explore geographic variations and time trends of the incidence of epilepsy and unprovoked seizures. [source]


    Quality-of-Life and Behavioral Outcome Measures in Randomized Controlled Trials of Antiepileptic Drugs: A Systematic Review of Methodology and Reporting Standards

    EPILEPSIA, Issue 11 2000
    Gus A. Baker
    Summary: Purpose: To review the methodology and use of quality-of-life and behavioral measures used in randomized controlled trials (RCTs) of antiepileptic drugs in patients with epilepsy. Methods: Trial reports were found by searching a previously developed comprehensive database of epilepsy RCTs and searching through journals by hand. Inclusion and exclusion criteria were applied, and methodological and quality-of-life and behavioral measure data were extracted. Results: There were 52 different measures used in 46 trials, with the Profile of Mood States, the Minnesota Multiphasic Personality Inventory, and the Washington Psychosocial Seizure Inventory being applied the most frequently. Overall, evidence of the reliability, validity, and sensitivity of measures used in populations of people with epilepsy was sparse. There was also little information on the clinical interpretation of the results. Conclusion: Our results highlight a consistent failure to apply quality-of-life and behavioral measures in RCTs in a systematic way. We found repeated evidence of researchers' failure to review the use of previous measures and selection of measures without evidence of their appropriateness for use in a population with epilepsy. We recommend the use of quality-of-life and behavioral measures in RCTs with proven psychometric properties in a population with epilepsy. [source]


    MTHFR 677C>T and ACE D/I Polymorphisms in Migraine: A Systematic Review and Meta-Analysis

    HEADACHE, Issue 4 2010
    Markus Schürks MD
    (Headache 2010;50:588-599) Background., Data on the association between the MTHFR 677C>T and ACE D/I polymorphisms and migraine including aura status are conflicting. Objective., The objective of this study is to perform a systematic review and meta-analysis on this topic. Methods., We searched for studies published until March 2009 using electronic databases (MEDLINE, EMBASE, Science Citation Index) and reference lists of studies and reviews on the topic. Assessment for eligibility of studies and extraction of data was performed by 2 independent investigators. For each study we calculated the odds ratios (OR) and 95% confidence intervals (CI) assuming additive, dominant, and recessive genetic models. We then calculated pooled ORs and 95% CIs. Results., Thirteen studies investigated the association between the MTHFR 677C>T polymorphism and migraine. The TT genotype was associated with an increased risk for any migraine, which only appeared for migraine with aura (pooled OR = 1.48, 95% CI 1.02-2.13), but not for migraine without aura. Nine studies investigated the association of the ACE D/I polymorphism with migraine. The II genotype was associated with a reduced risk for migraine with aura (pooled OR = 0.71, 95% CI 0.55-0.93) and migraine without aura (pooled OR = 0.84, 95% CI 0.70-0.99). Results for both variants were driven by studies in non-Caucasian populations. Results among Caucasians did not suggest an association. Extractable data did not allow investigation of gene,gene interactions. Conslusions., The MTHFR 677TT genotype is associated with an increased risk for migraine with aura, while the ACE II genotype is protective against both migraine with and without aura. Results for both variants appeared only among non-Caucasian populations. There was no association among Caucasians. [source]


    Helicobacter pylori Infection and Iron Stores: A Systematic Review and Meta-analysis

    HELICOBACTER, Issue 5 2008
    Khitam Muhsen
    Abstract Background and Aims:, We carried out a systematic literature review and meta-analysis to evaluate the existing evidence on the association between Helicobacter pylori infection and iron stores. Methods:, Twelve case reports and case series, 19 observational epidemiologic studies and six intervention trials were included in the review. Results:, Although only few studies controlled for multiple potential confounders, most studies reported a positive association, linking between H. pylori and decreased body iron stores in symptomatic and asymptomatic H. pylori -infected subjects. H. pylori infection may be regarded as a risk factor for reduction in body iron stores and also for iron deficiency or iron deficiency anemia, especially in high-risk groups. The results of the meta-analysis of thoroughly designed and analyzed studies revealed an increased risk for iron deficiency anemia; pooled odds ratio (OR) 2.8 (95% confidence interval (CI) 1.9, 4.2) and also for iron deficiency; pooled OR 1.38 (95%CI 1.16,1.65) among H. pylori -infected subjects. The biologic mechanism by which H. pylori induces the alteration in the iron stores is not fully understood, but it seems to involve several pathways, including gastrointestinal blood loss, decrease in the absorption of dietary iron, and enhanced uptake of the iron by the bacterium. Conclusions:,H. pylori is associated with reduced iron stores. Future research is needed to determine whether this relationship is a causal association and to better understand its biologic mechanism. The impact of anti- H. pylori therapy on improvement of iron stores needs to be further evaluated in large and well-controlled trials. [source]


    Outcomes Associated with Opioid Use in the Treatment of Chronic Noncancer Pain in Older Adults: A Systematic Review and Meta-Analysis

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2010
    Maria Papaleontiou MD
    This systematic review summarizes existing evidence regarding the efficacy, safety, and abuse and misuse potential of opioids as treatment for chronic noncancer pain in older adults. Multiple databases were searched to identify relevant studies published in English (1/1/80,7/1/09) with a mean study population age of 60 and older. Forty-three articles were identified and retained for review (40 reported safety and efficacy data, the remaining 3 reported misuse or abuse outcome data). The weighted mean subject age was 64.1 (mean age range 60,73). Studies enrolled patients with osteoarthritis (70%), neuropathic pain (13%), and other pain-producing disorders (17%). The mean duration of treatment studies was 4 weeks (range 1.5,156 weeks), and only five (12%) lasted longer than 12 weeks. In meta-analyses, effect sizes were ,0.557 (P<.001) for pain reduction, ,0.432 (P<.001) for physical disability reduction, and 0.859 (P=.31) for improved sleep. The effect size for the Medical Outcomes Study 36-item Health Survey was 0.191 (P=.17) for the physical component score and ,0.220 (P=.04) for the mental component score. Adults aged 65 and older were as likely as those younger than 65 to benefit from treatment. Common adverse events included constipation (median frequency of occurrence 30%), nausea (28%), and dizziness (22%) and prompted opioid discontinuation in 25% of cases. Abuse and misuse behaviors were negatively associated with older age. In older adults with chronic pain and no significant comorbidity, short-term use of opioids is associated with reduction in pain intensity and better physical functioning but poorer mental health functioning. The long-term safety, efficacy, and abuse potential of this treatment practice in diverse populations of older persons remain to be determined. [source]


    Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2010
    Michael A. LaMantia MD
    Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. A systematic review was conducted to identify and evaluate interventions to improve communication of accurate and appropriate medication lists and advance directives for elderly patients who transition between nursing homes and hospitals. MEDLINE, ISI Web, and EBSCO Host (from inception to June 2008) were searched for original, English-language research articles reporting interventions to improve communication of medication lists and advance directives. Five studies ultimately met all inclusion criteria. Two described interventions that enhanced transmission of advance directives, two described interventions that improved communication of medication lists, and one intervention addressed both goals. One study was a randomized controlled trial, whereas the remaining studies used historical or no controls. Study results indicate that a standardized patient transfer form may assist with the communication of advance directives and medication lists and that pharmacist-led review of medication lists may help identify omitted or indicated medications on transfer. Although preliminary evidence supports adoption of these methods to improve transitions between nursing home and hospital, further research is needed to define target populations and outcomes measures for high-quality transitional care. [source]


    Clinical Utility of Office-Based Cognitive Predictors of Fitness to Drive in Persons with Dementia: A Systematic Review

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006
    Frank J. Molnar MDCM
    OBJECTIVES: To perform a systematic review of evidence available regarding in-office cognitive tests that differentiate safe from unsafe drivers with dementia. DESIGN: A comprehensive literature search of multiple databases including Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. This was supplemented by a search of Current Contents and a review of the bibliographies of all relevant articles. SETTING: English prospective cohort, retrospective cohort, and case-control studies that used accepted diagnostic criteria for dementia or Alzheimer's disease and that employed one of the primary outcomes of crash, simulator assessment, or on-road assessment were included. PARTICIPANTS: Two reviewers. MEASUREMENTS: The reviewers independently assessed study design, main outcome of interest, cognitive tests, and population details and assigned a Newcastle-Ottawa quality assessment rating. RESULTS: Sixteen articles met the inclusion criteria. Tests recommended by guidelines (e.g., the American Medical Association (AMA) and Canadian Medical Association guidelines) for the assessment of fitness to drive did not demonstrate robustly positive findings (e.g., Mini-Mental State Examination, Trails B) or were not evaluated in any of the included studies (e.g., Clock Drawing). Fifteen studies did not report any cutoff scores. CONCLUSION: Without validated cutoff scores, it is impossible to employ tests in a standardized fashion in front-line clinical settings. This study identified a research gap that will prevent the development of evidence-based guidelines. Recommendations to address this gap are that driving researchers routinely perform cutoff score analyses and that stakeholder organizations (e.g., AMA, American Geriatrics Society) sponsor consensus fora to review driving research methodologies. [source]


    Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta-Analysis

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2004
    Julie D. Moreland MSc
    Objectives: To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults. Design: Random-effects meta-analysis. Setting: English-language studies indexed in MEDLINE and CINAHL (1985,2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers. Participants: Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community-dwelling subjects were included. Measurements: Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow-up for occurrence of falls. Methods: Sample size, population, setting, measure of muscle strength, and length of follow-up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement. Results: Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31,2.37) for any fall and 3.06 (95% CI=1.86,5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01,2.32) for any fall and 1.41 (95% CI=1.25,1.59) for recurrent falls. Conclusion: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle-strengthening exercises are effective in preventing falls. [source]


    Osteoporosis-Related Kyphosis and Impairments in Pulmonary Function: A Systematic Review,

    JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2007
    Robyn A Harrison
    Abstract We conducted a systematic review to examine the relationship between osteoporotic vertebral fractures, kyphosis, and pulmonary function. Findings suggest modest but predictable declines in vital capacity related to the degree of kyphosis. However, there were only four studies, and all had significant methodologic limitations. Further high-quality research is needed. Introduction: Our objective was to systematically review the extent to which osteoporosis-related vertebral fractures and kyphosis affect pulmonary function. Materials and Methods: We used a literature search from 1966 to 2006 (using Medline, EMBASE, and hand searches of references) for studies examining pulmonary function in patients without known lung disease who had vertebral fractures or kyphosis secondary to osteoporosis. Two reviewers independently abstracted data. Heterogeneity precluded formal meta-analysis. Results: Initial searches yielded 453 articles. After applying eligibility criteria, only four case-control studies of limited quality (e.g., only one study was blinded) remained. Since 1966, only 109 patients (6 men) have been studied. All four studies reported reductions in vital capacity (VC), with values ranging from 68% to 94% of predicted values. This was quantified as a 9% reduction in predicted VC per vertebral fracture in one study. The degree of kyphosis clinically (one study) or radiographically (three studies) correlated with declines in VC; impairments were most notable at kyphotic angles >55°. Statistically significant differences in percent predicted VC were obtained only when arm span or recalled height, rather than measured height, was used (two studies). Conclusions: Despite conventional teaching, the evidence relating osteoporotic vertebral fractures or kyphosis to pulmonary function is limited. On the basis of available studies, declines in VC secondary to kyphosis seem modest and directly related to the number of vertebral fractures or degree of kyphosis. Future studies need longitudinal follow-up of larger numbers of men and women, appropriate proxies for height, standardized measures for pulmonary function and kyphosis, and efforts to blind outcomes ascertainment. [source]


    Preoperative Intra-Aortic Balloon Pump in Patients Undergoing Coronary Bypass Surgery: A Systematic Review and Meta-Analysis

    JOURNAL OF CARDIAC SURGERY, Issue 1 2008
    Adel M. Dyub M.D., M.Sc.
    The primary outcome was hospital mortality and secondary outcomes were IABP-related complications (bleeding, leg ischemia, aortic dissection). Methods: MEDLINE, EMBASE, Cochrane registry of Controlled Trials, and reference lists of relevant articles were searched. We included randomized controlled trials (RCTs), and cohort studies that fulfilled our a priori inclusion criteria. Eligibility decisions, relevance, study validity, and data extraction were performed in duplicate using pre-specified criteria. Meta-analysis was conducted using a random effects model. Results: Ten publications fulfilled our eligibility criteria, of which four were RCTs and six were cohort studies with controls. There were statistical as well as clinical heterogeneity among included studies. A total of 1034 patients received preoperative IABP and 1329 did not receive preoperative IABP. The pooled odds ratio (OR) for hospital mortality in patients treated with preoperative IABP was 0.41 (95% CI, 0.21,0.82, p = 0.01). The number needed to treat was 17. The pooled OR for hospital mortality from randomized trials was 0.18 (95% CI, 0.06,0.57, p = 0.003) and from cohort studies was 0.54 (95% CI, 0.24,1.2, p = 0.13). Overall, 3.7% (13 of 349) of patients who received preoperative IABP developed either limb ischemia or haematoma at the IABP insertion site, and most of these complications improved after discontinuation of IABP. Conclusion: Evidence from this meta-analysis support the use of preoperative IABP in high-risk patients to reduce hospital mortality. [source]


    Improving Child Protection in the Emergency Department: A Systematic Review of Professional Interventions for Health Care Providers

    ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
    Amanda S. Newton PhD
    Abstract Objectives:, This systematic review evaluated the effectiveness of professional and organizational interventions aimed at improving medical processes, such as documentation or clinical assessments by health care providers, in the care of pediatric emergency department (ED) patients where abuse was suspected. Methods:, A search of electronic databases, references, key journals, and conference proceedings was conducted and primary authors were contacted. Studies whose purpose was to evaluate a strategy aimed at improving ED clinical care of suspected abuse were included. Study methodologic quality was assessed by two independent reviewers. One reviewer extracted the data, and a second checked for completeness and accuracy. Results:, Six studies met the inclusion criteria: one randomized controlled trial (RCT), one quasi-RCT, and four observational studies. Study quality ranged from modest (observational studies) to good (trials). Variation in study interventions and outcomes limited between-study comparisons. The quasi-RCT supported self-instructional education kits as a means to improve physician knowledge for both physical abuse (mean ± standard deviation [SD] pretest score = 13.12 ± 2.36; mean ± SD posttest score = 18.16 ± 1.64) and sexual abuse (mean ± SD pretest score = 10.81 ± 3.20; mean ± SD posttest score = 18.45 ± 1.79). Modest-quality observational studies evaluated reminder systems for physician documentation with similar results across studies. Compared to standard practice, chart checklists paired with an educational program increased physician consideration of nonaccidental burns in burn cases (59% increase), documentation of time of injury (36% increase), and documentation of consistency (53% increase) and compatibility (55% increase) of reported histories. Decisional flow charts for suspected physical abuse also increased documentation of nonaccidental physical injury (69.5% increase; p < 0.0001) and had a similar significant effect as checklists on increasing documentation of history consistency and compatibility (69.5 and 70.0% increases, respectively; p < 0.0001) when compared to standard practice. No improvements were noted in these studies for documentation of consultations or current status with child protective services. The introduction of a specialized team and crisis center to standardize practice had little effect on physician documentation, but did increase documentation of child protective services involvement (22.7% increase; p < 0.005) and discharge status (23.7% increase; p < 0.02). Referral to social services increased in one study following the introduction of a chart checklist (8.6% increase; p = 0.018). A recently conducted multisite RCT did not support observational findings, reporting no significant effect of educational sessions and/or a chart checklist on ED practices. Conclusions:, The small number of studies identified in this review highlights the need for future quality studies that address care of a vulnerable clinical population. While moderate-quality observational studies suggest that education and reminder systems increase clinical knowledge and documentation, these findings are not supported by a multisite randomized trial. The limited theoretical base for conceptualizing change in health care providers and the influence of the ED environment on clinical practice are limitations to this current evidence base. ACADEMIC EMERGENCY MEDICINE 2010; 17:117,125 © 2010 by the Society for Academic Emergency Medicine [source]


    The Costs and Quality-of-Life Outcomes of Drug-Eluting Coronary Stents: A Systematic Review

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2007
    M.S., PETER W. GROENEVELD M.D.
    Objectives: While the efficacy of drug-eluting coronary stents (DES) has been demonstrated by several clinical trials, the impact of DES on health-care costs and recipient quality of life (QOL) is controversial. We performed a systematic review of the published literature on DES costs and the QOL effects of restenosis and target vessel revascularization (TVR). Methods: Among 536 potential articles initially identified by a broad search, 12 publications ultimately met inclusion criteria. Data were independently abstracted, evaluated for quality and relevance, and summarized by two reviewers. Excessive heterogeneity among these studies prevented formal meta-analysis, thus a narrative synthesis of the literature was performed. Results: In four economic studies, DES recipients had $1,600,$3,200 higher up-front costs than recipients of bare metal stents, but the differences in total costs after 1 year were less pronounced ($200,$1,200), and estimates of the average cost of an avoided revascularization ranged widely ($1,800,$36,900). All eight QOL studies indicated that restenosis was associated with lower QOL, but only two studies quantified this in terms of quality-adjusted life years (QALYs), with estimates ranging from 0.06 to 0.08. An additional study estimated that the median willingness to pay to prevent restenosis was $2,400,$3,600. Conclusions: There is a lack of convergence in the literature on the cost of DES in avoiding TVR. There is more agreement that the average QALY benefit of an avoided revascularization is 0.04,0.08. This implies that use of DES in patients where the average cost per avoided revascularization exceeds $8,000 may be less likely to be cost-effective. [source]


    CLINICAL SCHOLARSHIP: Systematic Review of Educational Interventions for Improving Advance Directive Completion

    JOURNAL OF NURSING SCHOLARSHIP, Issue 3 2010
    Christine R. Durbin RN
    Abstract Purpose: To systematically analyze evidence about the outcome and percent of newly completed ADs, focusing on the effectiveness of (a) types of educational interventions versus controls and (b) one educational intervention over another. Design: Systematic review of literature based on Cochrane review criteria. Methods: Twelve randomized and four nonrandomized studies were selected from the nursing, medical, and social work literature that met the following criteria: described educational interventions, provided information to calculate the percent of newly completed ADs as an outcome, and published between 1991 and 2009. The review focused primarily on randomized studies. Reviewers calculated the percent of newly completed ADs by determining the number of subjects per group without an AD at baseline and the percentage of those who then completed one by the end of the studies. Findings: Findings were inconsistent regarding all types of educational interventions studied versus controls. Sufficient evidence exists to conclude that combined written and verbal educational interventions were more effective than single written interventions in increasing the percent of newly completed ADs in adult clinic outpatients and hospitalized elderly. Conclusions: Calculating the percent of newly completed ADs was successful in allowing for study result comparisons. Overall, the evidence base regarding the effectiveness of single or combined educational interventions in increasing AD completion is weak. Randomized studies with diverse samples should be conducted against controls before more studies comparing interventions are undertaken. Clinical Relevance: This article provides nurses with a summary of research related to educational interventions and AD completion and identifies where future study is needed. [source]


    A Systematic Review of the Effectiveness of Breastfeeding Intervention Delivery Methods

    JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2009
    Barbara Pate
    ABSTRACT Objective: To analyze breastfeeding intervention delivery methods to determine the likelihood of successful breastfeeding outcomes of e-based interventions compared to provider-based interventions. Data Sources: Eligible studies were identified by searching MEDLINE, CINAHL, Academic Search Elite, Health Source: Nursing/Academic Edition, SOC INDEX, and PsycINFO. Study Selection: Studies were included if they were conducted in a developed country, published between the years 2004 and 2008, included a concurrent control group, and reported frequency data on breastfeeding initiation or duration. The suitability of design and quality of execution were evaluated using the Centers for Disease Control procedure for systematic reviews. Twenty-one articles met the criteria for inclusion. Data Extraction: Study design, demographics, intervention/control conditions, settings, sampling strategies, potential threats to validity, and breastfeeding outcomes were abstracted and entered into a database for analysis and synthesis. Data Synthesis: Odds ratios were calculated for each individual study, and studies were stratified into 2 groups by intervention delivery type. The pooled results indicated that studies using e-based interventions had a moderate effect on breastfeeding (odds ratio=2.2 [1.9-2.7], d=0.5); whereas provider-based interventions had very little to no effect (odds ratio=1.1 [1.0-1.2], d=0.03). Conclusions: Results indicate that breastfeeding promotion programs delivered via the Internet may be an appealing alternative to time-consuming and expensive provider-based breastfeeding education and support. [source]


    Acupuncture for Alcohol Dependence: A Systematic Review

    ALCOHOLISM, Issue 8 2009
    Seung-Hun Cho
    Background:, Acupuncture has been used in the treatment of substance-related disorders for the past 30 years. However, a systematic review to assess the effect of various types of acupuncture for alcohol dependence has not yet been performed. The present systematic review assessed the results of randomized controlled trials (RCTs). Methods:, Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs of acupuncture for alcohol dependence up to June 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Cochrane Handbook. Results:, Eleven studies, which comprised a total of 1,110 individual cases, were systematically reviewed. Only 2 of 11 trials reported satisfactorily all quality criteria. Four trials comparing acupuncture treatment and sham treatments reported data for alcohol craving. Three studies reported that there were no significant differences. Among 4 trials comparing acupuncture and no acupuncture with conventional therapies, 3 reported significant reductions. No differences between acupuncture and sham treatments were found for completion rates (Risk Ratio = 1.07, 95% confidence interval, CI = 0.91 to 1.25) or acupuncture and no acupuncture (Risk Ratio = 1.15, 95% CI = 0.79 to 1.67). Only 3 RCTs reported acupuncture-related adverse events, which were mostly minimal. Conclusions:, The results of the included studies were equivocal, and the poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence. More research and well-designed, rigorous, and large clinical trials are necessary to address these issues. [source]


    A Systematic Review of Dowel (Post) and Core Materials and Systems

    JOURNAL OF PROSTHODONTICS, Issue 6 2009
    Joanna N. Theodosopoulou DDS
    Abstract Purpose: The aim of this systematic review was to determine which dowel (post) and core system is the most successful when used in vivo to restore endodontically treated teeth. Materials and Methods: A MEDLINE, a Cochrane, and an EMBASE search (three specified searches) were conducted to identify randomized (RCT) and nonrandomized controlled clinical trials (CCT), cohort (CS), and case control studies (CCS) until January 2008, conducted on humans, and published in English, German, and French, relating to dowel and core systems for restoring endodontically treated teeth. Also, a hand search was conducted, along with contact with the authors when needed. Results: The MEDLINE, Cochrane, and EMBASE searches identified 997, 141, and 25 published articles, respectively. Ten articles from the MEDLINE and seven articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and validity assessment criteria. Six out of the ten studies were RCTs, two were CCTs, and two CSs. The RCT studies suggest that carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (number needed to treat, NNT = 8.30). Tapered gold alloy cast dowels are better than ParaPost® gold alloy cast dowels (NNT = 13.15). ParaPost® prefabricated dowels are slightly better than ParaPost® cast dowels (NNT = 175.4). Glass fiber dowels are significantly better than metal screw dowels (NNT = 5.46), but worse than titanium (NNT =,21.73) (moderately). Carbon fiber dowels are worse than gold alloy cast dowels (significantly) (NNT =,5.81) and than amalgam dowels (NNT =,125) (slightly). The CCT studies suggest that metal dowels are better (NNT = 21.73) but also worse than cast dowels (NNT =,33.33) depending on the remaining amount of coronal hard tissue. Quartz fiber dowels show success rates similar to and worse than glass fiber-reinforced dowels (NNT =,37.03). The results from the CS studies suggest that carbon fiber in resin matrix dowels are better (moderately) than carbon fiber + quartz and quartz fiber dowels. Titanium dowels with a composite build-up are better (moderately) than gold alloy cast dowels. Conclusions: According to the studies of the highest levels of evidence, carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (RCT). Glass fiber dowels are significantly better than metal screw dowels (RCT) and moderately better than quartz fiber dowels (CCT). Carbon fiber dowels are significantly worse than metal dowels (of precious alloy) (RCT). Prefabricated metal dowels are slightly better than cast dowels (RCT), but moderately worse when no collar of the dentin above the gingiva could be achieved (CCT). [source]


    Dental Amalgam and Multiple Sclerosis: A Systematic Review and Meta-Analysis

    JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2007
    Kevin K. Aminzadeh Bsc Pharm
    Abstract Objectives: Amalgam restorations have long been controversial due to their mercury content. Allegations that the mercury may be linked to nervous disorders such as Alzheimer's, chronic fatigue syndrome, and multiple sclerosis (MS) have fueled the calls for the removal of amalgam restorations from dentists' armamentarium. To explore and quantify the association between amalgam restorations and MS we have conducted a systematic review and meta-analysis of the literature. Methods: A systematic search in Medline (from 1966 to April 2006), EMBASE (2006, Week 16), and the Cochrane library (Issue 2, 2006) for English-language articles meeting specific definitions of MS and amalgam exposure was conducted. Studies were also identified using the references of retrieved articles. Studies were independently reviewed by two authors and disagreements were resolved by consensus. Studies were selected based on an a priori of defined criteria. Odds ratios (ORs) or relative risks were pooled using the random effects model. Heterogeneity was assessed using Q statistics. Results: The pooled OR for the risk of MS among amalgam users was consistent, with a slight, nonstatistically significant increase between amalgam use and risk of MS. Conclusion: Future studies that take into consideration the amalgam restoration size and surface area along with the duration of exposure are needed in order to definitively rule out any link between amalgam and MS. [source]


    Prevalence of Xerostomia in Population-based Samples: A Systematic Review

    JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2006
    M.F. Orellana DDS
    Abstract The consequences of xerostomia on oral health have been studied for decades; however, the actual prevalence of this disorder on the general population remains controversial. The purpose of this systematic review was to determine the prevalence of xerostomia in population-based samples. Electronic databases were screened for relevant articles and reference lists of pertinent articles were also hand-searched. Thirteen articles meeting the final inclusion criteria were identified. Based on the definition of xerostomia used in this review, only publications including a subjective diagnosis of the disorder were included. All of the self-repotted diagnoses were achieved through a questionnaire either by mail, telephone, interview or self-administered by the patient. There was a variation across papers regarding number and content of the questions as well as guidelines for the diagnosis of xerostomia (i.e. answer yes to one or more than one question). The prevalence of xerostomia in the selected articles ranged from 0.9% to 64.8%. The majority of these studies were performed in Scandinavia. In 9 of the articles, the studied samples were 50 years and older. None of the studies evaluated the prevalence xerostomia among individuals younger than 18 years. Based on these observations, it can be concluded that there is a need for population-based studies on prevalence of xerostomia in regions other than Scandinavia. A standardized protocol to diagnose xerostomia needs to be developed. Patient-perceived treatment needs and impact on quality of life should be included to have a complete picture of public health implications of the disease. [source]


    A Systematic Review of the Performance of Methods for Identifying Carious Lesions

    JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2002
    James D. Bader DDS
    Abstract This systematic review evaluates evidence describing histologically validated performance of methods for identifying carious lesions. A search identified 1,407 articles, of which 39 were included that described 126 assessments of visual, visuaVtactile, radiographic (film and digital), fiber optic transillumination, electrical conductance, and laser fluorescence methods. A subsequent update added four studies contributing 10 assessments. The strength of the evidence was judged to be poor for all applications, signifying that the available information is insufficient to supporf generalizable estimates of the sensitivity and specificity of any given application of a diagnostic method. The literature is problematic with respect to complete reporting of methods, variations in histological validation methods, the small number of in vivo studies, selection of teeth, small numbers of examiners, and other factors threatening both internal and external validity. Future research must address these problems as well as expand the range of assessments to include primary teeth and root surfaces. [source]


    Genetic Polymorphisms Related to Delirium Tremens: A Systematic Review

    ALCOHOLISM, Issue 2 2007
    Barbara C. Van Munster
    Background: Delirium tremens (DT) is one of the more severe complications of alcohol withdrawal (AW), with a 5 to 10% lifetime risk for alcohol-dependent patients. The 2 most important neurosystems involved in AW are , -aminobutyric acid and glutamate. It is unknown whether these neurosystems are involved in the pathophysiology of DT as well. The candidate gene approach in DT could contribute to this knowledge and demonstrate a possible genetic predisposition for DT. The purpose of this study is to give an overview of all studied genetic polymorphisms in the diverse candidate genes related to DT and to summarize what these studies contribute to insights into the pathophysiology of DT. Methods: The inclusion criteria for this literature study were articles in English analyzing the association between a genetic polymorphism and DT without other AW syndromes. Studies were identified until February 2006 in MEDLINE and EMBASE databases. Results: We found 25 studies dealing with 30 polymorphisms, located in 19 different genes. Positive associations were found in 3 different candidate genes involved in the dopamine transmission, 1 gene involved in the glutamate pathway, 1 neuropeptide gene, and 1 cannabinoid gene. Two candidate genes involved in the dopamine transmission, dopamine receptor D3, and solute carrier family 6, were each associated with DT in 2 different study populations. The other 4 positive associations were not replicated in other studies. Conclusions: A total of 8 positive associations out of 30 polymorphisms makes a genetic base for DT plausible. Understanding the pathophysiological process of the development of DT has, indeed, been augmented by the reviewed genetic association studies. These studies suggest that the regulation of dopaminergic neurotransmission may play an important role. [source]


    Treatment of Hypertriglyceridemia With Omega-3 Fatty Acids: A Systematic Review

    JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2004
    Amanda Lewis MS
    Purpose To (a) critically appraise available randomized controlled trials (RCTs) addressing the efficacy of long-chain omega-3 fatty acids as secondary agents for prevention of hypertriglyceridemia and (b) make recommendations for clinical practice. Data Sources Two independent reviewers examined all RCTs from 1994 to 2003 identified in several databases, extracted data from each study, and used the previously tested Boyack and Lookinland Methodological Quality Index (MQI) to determine study quality. Conclusions Ten studies reported long-chain omega-3 fatty acids to be effective in the treatment of hypertriglyceridemia. The average decrease in triglycerides was 29%, total cholesterol 11.6%, very low density lipoprotein (VLDL) 30.2%, and low-density lipoprotein (LDL) 32.5%. One study found LDLs to increase by 25%. The average increase in highdensity lipoprotein was 10%. The overall average MQI score was 36% (range = 26% to 54%). Many of the RCTs had serious shortcomings, including short duration, lack of a power analysis, no intention-to-treat analysis, no report of blind assessment of outcome, and lack of dietary control as a confounding variable. Implications for Practice Overall study methodology was weak. Although the evidence supporting use of long-chain omega-3 fatty acids in the secondary prevention of hypertriglyceridemia is reasonably strong, until there are larger RCTs of better methodological quality, it is not recommended that practitioners treat hypertriglyceridemia with omega-3 fatty acid supplementation in lieu of lipid-lowering medications. [source]


    Efficacy of Raloxifene for Treatment of Menopause: A Systematic Review

    JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 4 2002
    Mark Boyack MSN
    Purpose To critically appraise recent randomized controlled trials (RCT) of raloxifene and its effects on the long-term consequences of menopause. Data Sources All RCTs of greater than six months duration in post-menopausal women found in MEDLINE through July 2000. Conclusions Raloxifene lowered lipids, but estrogen had a more beneficial effect on HDL and fibrinolytic markers. Raloxifene had a more beneficial effect on triglycerides, inflammatory and thrombogenic markers. Compared to placebo, raloxifene reduced vertebral fractures but had a similar although lesser effect on bone mineral density and markers of bone turnover than estrogen. Estrogen receptor positive breast cancer was reduced by 90% with no increase in the incidence of endometrial cancer with raloxifene. The most serious side effect of raloxifene was an increased incidence of deep vein thromboses and pulmonary emboli. Implications Raloxifene has been shown to be beneficial using cardiovascular and osteoporosis endpoints in studies of short duration. More RCTs of longer duration with comparisons to other traditional treatments are needed before raloxifene becomes the treatment of choice. [source]


    Pretreatment Psychosocial Variables as Predictors of Outcomes Following Lumbar Surgery and Spinal Cord Stimulation: A Systematic Review and Literature Synthesis

    PAIN MEDICINE, Issue 4 2009
    James Celestin MD
    ABSTRACT Background., In the multimodal treatment approach to chronic back pain, interventional back procedures are often reserved for those who do not improve after more conservative management. Psychological screening prior to lumbar surgery or spinal cord stimulation (SCS) has been widely recommended to help identify suitable candidates and to predict possible complications or poor outcome from treatment. However, it remains unclear which, if any, variables are most predictive of pain-related treatment outcomes. Objective., The intent of this article is to perform a systematic review to examine the relationship between presurgical predictor variables and treatment outcomes, to review the existing evidence for the benefit of psychological screening prior to lumbar surgery or SCS, and to make treatment recommendations for the use of psychological screening. Results., Out of 753 study titles, 25 studies were identified, of which none were randomized controlled trials and only four SCS studies met inclusion criteria. The methodological quality of the studies varied and some important shortcomings were identified. A positive relationship was found between one or more psychological factors and poor treatment outcome in 92.0% of the studies reviewed. In particular, presurgical somatization, depression, anxiety, and poor coping were most useful in helping to predict poor response (i.e., less treatment-related benefit) to lumbar surgery and SCS. Older age and longer pain duration were also predictive of poorer outcome in some studies, while pretreatment physical findings, activity interference, and presurgical pain intensity were minimally predictive. Conclusions., At present, while there is insufficient empirical evidence that psychological screening before surgery or device implantation helps to improve treatment outcomes, the current literature suggests that psychological factors such as somatization, depression, anxiety, and poor coping, are important predictors of poor outcome. More research is needed to show if early identification and treatment of these factors through psychological screening will enhance treatment outcome. [source]