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Selected AbstractsLiterature review: considerations in undertaking focus group research with culturally and linguistically diverse groupsJOURNAL OF CLINICAL NURSING, Issue 6 2007Elizabeth J Halcomb BN, IC Cert Aims., This integrated literature review seeks to identify the key considerations in conducting focus groups and discusses the specific considerations for focus group research with culturally and linguistically diverse groups. Background., The focus group method is a technique of group interview that generates data through the opinions expressed by participants. Focus groups have become an increasingly popular method of data collection in health care research. Although focus groups have been used extensively with Western populations, they are a particularly useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is dependent upon the cultural competence of the research team and the research questions. Methods., The electronic databases Medline, CINAHL, Embase, Psychlit and the Internet using the Google Scholar search engine were explored using the search terms ,focus group', ,cultural sensitivity', ,transcultural nursing', ,transcultural care', ,cultural diversity' and ,ethnic groups'. Hand searching of reference lists and relevant journals was also undertaken. English language articles were selected for the review if they discussed the following issues: (i) methodological implications of the focus group method; (ii) strengths and limitations of the focus group method; (iii) recommendations for researchers and (iv) use of the focus group in culturally and linguistically diverse groups. Conclusions were drawn from each of the articles and consensus regarding a summary of recommendations was derived from a minimum of two authors. Results., Findings from this review revealed several key issues involving focus group implementation including recruitment, sample size, data collection, data analysis and use within multicultural populations. Strengths and limitations of the focus group method were also identified. Conclusions., Focus groups are a useful tool to expand existing knowledge about service provision and identify consumer needs that will assist in the development of future intervention programmes, particularly within multicultural populations. Careful planning related to methodological and pragmatic issues are critical in deriving effective data and protecting participants. Relevance to clinical practice., Focus groups can facilitate increased understanding of perspectives of culturally and linguistically diverse groups and thereby shape clinical practice to better meet the needs of these groups. [source] A systematic review of multivitamin and multimineral supplementation for infectionJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2006A. I. Stephen Abstract Background, Infections are major causes of morbidity and mortality worldwide. Micronutrients have important functions in the body's immune system. This systematic review examined the evidence from randomized controlled trials (RCTs) on whether multivitamin and multimineral supplementation is effective in reducing infection. Methods, Electronic databases searched: Cochrane Controlled Trials Register, EMBASE, MEDLINE, BIOSIS, CAB abstracts. Hand searching of nutrition journals and reference lists was carried out. RCTs and quasi-randomized trials of supplementation of adults with at least two vitamins or minerals or a combination were selected. Study results were combined in meta-analysis plots where appropriate. Results, Twenty studies were included in the review. Small numbers were available for each meta-analysis. Results are presented here without the Chandra group studies. No significant difference was found in the number of episodes of infection in older people (,65 years) between those supplemented and those not supplemented; (WMD) 0.06 [95% confidence interval (CI) ,0.04, 0.16], P = 0.25. In other adults groups, there were significantly less episodes of infection in those supplemented; (WMD) ,1.20 (95% CI ,2.08, ,0.32), P = 0.008. There was no significant difference between those older people supplemented and those not supplemented in the number with at least one infection; relative risk (RR) 0.98 (95% CI 0.86, 1.11), P = 0.77. Similarly, there was no significant difference in the numbers in other adult groups who had at least one episode of infection between those supplemented and those taking placebo; (RR) 0.81 (95% CI 0.65, 1.00), P = 0.06. Subgroup analyses suggested that supplemented people aged 65 years or over may benefit more if they are undernourished and supplemented for over 6 months, WMD ,0.67 infections (95% CI ,1.24, ,0.10), P = 0.02. Conclusion, Further large trials are needed, particularly in undernourished older people. Trials of supplementation periods of over 6 months are recommended. [source] Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trialsDIABETIC MEDICINE, Issue 6 2010K. Hawthorne Diabet. Med. 27, 613,623 (2010) Abstract To determine if culturally appropriate health education is more effective than ,usual' health education for people with diabetes from ethnic minority groups living in high- and upper-middle-income countries. A systematic review with meta-analysis, following the methodology of the Cochrane Collaboration. Electronic literature searches of nine databases were made, with hand searching of three journals and 16 author contacts. The criteria for inclusion into the analysis were randomized controlled trials of a specified diabetes health education intervention, and a named ethnic minority group with Type 2 diabetes. Data were collected on HbA1c, blood pressure, and quality-of-life measures. A narrative review was also performed. Few studies fitted the selection criteria, and were heterogeneous in methodologies and outcome measures, making meta-analysis difficult. HbA1c showed an improvement at 3 months [weighted mean difference (WMD) ,0.32%, 95% confidence interval (CI) ,0.63, ,0.01] and 6 months post intervention (WMD ,0.60%, 95% CI ,0.85, ,0.35). Knowledge scores also improved in the intervention groups at 6 months (standardized mean difference 0.46, 95% CI 0.27, 0.65). There was only one longer-term follow-up study, and one formal cost-effectiveness analysis. Culturally appropriate health education was more effective than ,usual' health education in improving HbA1c and knowledge in the short to medium term. Due to poor standardization between studies, the data did not allow determination of the key elements of interventions across countries, ethnic groups and health systems, or a broad view of their cost-effectiveness. The narrative review identifies learning points to direct future research. [source] Options in Prehospital analgesiaEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2002Meredith L Borland Abstract Background: Prehospital analgesia options for paramedics have been limited due to the difficulty in achieving safe and effective pain relief without compromising transportation to hospital. The present paper identifies the analgesia methods currently available in the prehospital setting so as to evaluate the various options and highlight areas for future research. Methods: A literature review of Medline and Embase databases from 1966 until the present was undertaken. Further hand searching of all the references identified in these papers was also performed. All current literature was analysed and categorized according to one of four levels of evidence using National Health and Medical Research Council of Australia guidelines (1999). Results: There is a paucity of randomized control trials relating to prehospital analgesia. All published literature was level III or IV prospective or retrospective studies. Drug options used included nitrous oxide/oxygen mixtures, intravenous/intramuscular nalbuphine, intravenous tramadol and intravenous pure opiate agonists. Conclusions: The evidence supporting analgesic options in the prehospital setting is limited. There are few published data in this area despite the inadequacy of pain relief being recognized as a weakness in prehospital care. Prehospital analgesia is an area worthy of innovative methods for the administration of safe and effective analgesics without significant impact on transport times. Such methods should be prospectively evaluated in well-constructed trials. [source] Sources of information on adverse effects: a systematic reviewHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 3 2010Su Golder Background:, Systematic reviews can provide accurate and timely information on adverse effects. An essential part of the systematic review process is a thorough search of the literature. This often requires searching many different sources. However, it is unclear which sources are most effective at providing information on adverse effects. Objective:, To identify and summarise studies that have evaluated sources of information on adverse effects. Methods:, Studies were located by searching in 10 databases as well as by reference checking, hand searching, citation searching and contacting experts. Results:, A total of 6218 citations were retrieved yielding 19 studies which met the inclusion criteria. The included studies tended to focus on the adverse effects of drug interventions and compare the relative value of different sources using the number of relevant references retrieved from searches of each source. However, few studies were conducted recently with a large sample of references. Conclusions:, This review suggests that embase, Derwent Drug File, medline and industry submissions may potentially provide the greatest number of relevant references for information on adverse effects of drugs. However, a systematic evaluation of the current value of different sources of information for adverse effects is urgently required. [source] Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2008Deborah Parker BA, MSocSci Executive summary Objectives, The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Inclusion criteria, Types of participants, Adult caregivers who provide support for people with dementia living in the community (non-institutional care). Types of interventions, Interventions designed to support caregivers in their role such as skills training, education to assist in caring for a person living with dementia and support groups/programs. Interventions of formal approaches to care designed to support caregivers in their role, care planning, case management and specially designated members of the healthcare team , for example dementia nurse specialist or volunteers trained in caring for someone with dementia. Types of studies, This review considered any meta-analyses, systematic reviews, randomised control trials, quasi-experimental studies, cohort studies, case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Search strategy, The search sought to identify published studies from 2000 to 2005 through the use of electronic databases. Only studies in English were considered for inclusion. The initial search was conducted of the databases, CINAHL, MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. A second more extensive search was then conducted using the appropriate Medical Subject Headings (MeSH) and keywords for other available databases. Finally, hand searching of reference lists of articles retrieved and of core dementia, geriatric and psycho geriatric journals was undertaken. Assessment of quality, Methodological quality of each of the articles was assessed by two independent reviewers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Reviews and Dissemination. Data collection and analysis, Standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each included study reported in the meta-analysis. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software from the Cochrane Collaboration. Heterogeneity between combined studies was tested using standard chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. Results, A comprehensive search of relevant databases, hand searching and cross referencing found 685 articles that were assessed for relevance to the review. Eighty-five papers appeared to meet the inclusion criteria based on title and abstract, and the full paper was retrieved. Of the 85 full papers reviewed, 40 were accepted for inclusion, three were systematic reviews, three were meta-analysis, and the remaining 34 were randomised controlled trials. For the randomised controlled trials that were able to be included in a meta-analysis, standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. The results are discussed in two main sections. Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression, health, subjective well-being, self-efficacy and burden. Secondly, results are reported by main outcome category. For each of these sections, meta-analysis was conducted where it was possible; otherwise, a narrative summary describes the findings. Effectiveness of intervention type, Four categories of intervention were included in the review , psycho-educational, support, multi-component and other. Psycho-educational Thirteen studies used psycho-educational interventions, and all but one showed positive results across a range of outcomes. Eight studies were entered in a meta-analysis. No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being, self-efficacy or health. However, small but significant results were found for the categories of depression and burden. Support Seven studies discussed support only interventions and two of these showed significant results. These two studies were suitable for meta-analysis and demonstrated a small but significant improvement on caregiver burden. Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy, depression, subjective well-being and burden. Unfortunately because of the heterogeneity of study designs and outcome measures, no meta-analysis was possible. Other interventions Other interventions included the use of exercise or nutrition which resulted in improvements in psychological distress and health benefits. Case management and a computer aided support intervention provided mixed results. One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour. Effectiveness of interventions using specific outcome categories, In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies. In particular the impact of interventions on caregiver depression was available for meta-analysis from eight studies. This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression. Five studies using the outcome category of caregiver burden were entered into a meta-analysis and findings indicated that there were no significant effects of any of interventions. No meta-analysis was possible for the outcome categories of health, self-efficacy or subjective well-being. Implications for practice, From this review there is evidence to support the use of well-designed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community. Factors that appear to positively contribute to effective interventions are those which: ,,Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved ,,Encourage active participation in educational interventions for caregivers ,,Offer individualised programs rather than group sessions ,,Provide information on an ongoing basis, with specific information about services and coaching regarding their new role ,,Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which: ,,Simply refer caregivers to support groups ,,Only provide self help materials ,,Only offer peer support [source] The effectiveness of antidepressant medication in the management of behaviour problems in adults with intellectual disabilities: a systematic reviewJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2007S. K. Sohanpal Abstract Background A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities. Method An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time period 1990 to October 2005 for primary trials. This was supplemented by hand searching and cross-referencing of relevant reviews. Strict scientific methodology requirements were formulated that the studies had to meet in order to merit inclusion in this review. Results One crossover randomized controlled trial in a small cohort, seven prospective uncontrolled trials and two retrospective studies were yielded in the search. Of these, one explored the effectiveness of the tricyclic antidepressant , clomipramine, and nine considered various selective serotonin reuptake inhibitors (SSRIs). Conclusion Evidence based primarily on a small number of either prospective or retrospective case studies that included a small number of participants and often used non-validated outcome measures for a short period of follow-up, suggests that antidepressants, particularly SSRIs, show improvement of aggression and self-injurious behaviour on average in less than 50% of cases and the rest show either no improvement or deterioration. The effect is most pronounced in the presence of an underlying anxiety or an associated diagnosis of obsessive-compulsive disorder. Most studies have highlighted the concern regarding adverse effects. [source] Psychiatric diagnosis, intellectual disabilities and Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD)JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 2003Sally-Ann Cooper Abstract Background Classification of psychopathology using operationalized diagnostic criteria is one component of psychiatric assessment. Previous literature has demonstrated that there are limitations in the International Classification of Diseases,10 (ICD-10) and the Diagnostic and Statistical Manual,IV (DSM-IV) when used with adults with intellectual disabilities. Methods A literature search using Medline, PsychLIT and hand searching of key journals identified the existing literature, which was reviewed by the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) Development Working Group. Key findings are integrated into this paper. This, together with expert consensus led to the development of DC-LD, a new psychiatric classificatory system devised specifically for use with adults with intellectual disabilities. The new diagnostic criteria and classification within DC-LD were piloted with 52 field investigators drawing on 709 clinical cases. Validity of DC-LD classification was measured by comparison between the criteria providing DC-LD diagnosis and the gold standard of learning disabilities psychiatric assessment. Results In 96.3% of cases, the DC-LD diagnosis was fully concordant with that of clinical opinion. The few discrepancies related to level of detail. Conclusion DC-LD accommodates the pathoplastic effect of intellectual disabilities on psychopathology. Its use will hopefully improve clinical practice and facilitate research, but further work to determine its usefulness and limitations is required. [source] Evidence for benefit of transversus abdominis training alone or in combination with pelvic floor muscle training to treat female urinary incontinence: A systematic review,,NEUROUROLOGY AND URODYNAMICS, Issue 5 2009Kari Bø Abstract Aims Pelvic floor muscle training (PFMT) has Level A evidence to treat female urinary incontinence (UI). Recently, indirect training of the pelvic floor muscles (PFM) via the transversus abdominis muscle (TrA) has been suggested as a new method to treat UI. The aim of this article is to discuss whether there is evidence for a synergistic co-contraction between TrA and PFM in women with UI, whether TrA contraction is as effective, or more effective than PFMT in treating UI and whether there is evidence to recommend TrA training as an intervention strategy. Methods A computerized search on PubMed, and hand searching in proceedings from the meetings of the World Confederation of Physical Therapy (1993,2007), International Continence Society and International Urogynecology Association (1990,2007) were performed. Results While a co-contraction of the TrA normally occurs with PFM contraction, there is evidence that a co-contraction of the PFM with TrA contraction can be lost or altered in women with UI. No randomized controlled trials (RCTs) were found comparing TrA training with untreated controls or sham. Two RCTs have shown no additional effect of adding TrA training to PFMT in the treatment of UI. Conclusions To date there is insufficient evidence for the use of TrA training instead of or in addition to PFMT for women with UI. Neurourol. Urodyn. 28:368,373, 2009. © 2009 Wiley-Liss, Inc. [source] Leadership and management in the aged care sector: A narrative synthesisAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2010Yun-Hee Jeon The aim of this study is to examine the issues and the progress being made in leadership and management with relevance for the residential aged care workforce. A systematic review was conducted using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts. After a seven-tiered culling process, we conducted a detailed review of 153 papers relevant to leadership and management development in aged care. Strong, effective leadership and management promotes staff job satisfaction and retention, high care quality and the well-being of care recipients, and reduces associated costs. Good leadership and effective management also play a key role in bringing about a successful change to a positive workplace culture through innovative programs and research projects. Organisational investment in improving leadership and management skills and capabilities can only improve outcomes for staff stability and productivity, care quality and budgets, and better prepare the aged care sector. [source] A systematic review of intravesical bacillus Calmette-Guérin plus transurethral resection vs transurethral resection alone in Ta and T1 bladder cancerBJU INTERNATIONAL, Issue 3 2001M.D. Shelley Objective,To assess, in a systematic review, the effectiveness of intravesical bacillus Calmette-Guérin (BCG) in preventing tumour recurrence in patients with medium/high risk Ta and T1 bladder cancer. Patients and methods,An electronic database search of Medline, Embase, DARE, the Cochrane Library, Cancerlit, Healthstar and BIDS was undertaken, plus hand searching of the Proceedings of ASCO, for randomized controlled trials, in any language, comparing transurethral resection (TUR) alone with TUR followed by intravesical BCG in patients with Ta and T1 bladder cancer. Results,The search identified 26 publications comparing TUR with TUR + BCG. Six trials were considered acceptable, representing 585 eligible patients, 281 in the TUR-alone group and 304 in the TUR + BCG group. The major clinical outcome chosen was tumour recurrence. The weighted mean log hazard ratio for the first recurrence, taken across all six trials, was ,0.83 (95% confidence interval ,0.57 to ,1.08, P < 0.001), which is equivalent to a 56% reduction in the hazard, attributable to BCG. The Peto odds ratio for patients recurring at 12 months was 0.3 (95% confidence interval of 0.21,0.43, P < 0.001), significantly favouring BCG therapy. Manageable toxicities associated with intravesical BCG were cystitis (67%), haematuria (23%), fever (25%) and urinary frequency (71%). No BCG-induced deaths were reported. Conclusion,TUR with intravesical BCG provides a significantly better prophylaxis of tumour recurrence in Ta and T1 bladder cancer than TUR alone. Randomized trials are still needed to address the issues of BCG strain, dose and schedule, and to better quantify the effect on progression to invasive disease. [source] Breastfeeding promotion for infants in neonatal units: a systematic reviewCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2010M. J. Renfrew Abstract Background Breastfeeding/breastmilk feeding of infants in neonatal units is vital to the preservation of short- and long-term health, but rates are very low in many neonatal units internationally. The aim of this review was to evaluate the effectiveness of clinical, public health and health promotion interventions that may promote or inhibit breastfeeding/breastmilk feeding for infants admitted to neonatal units. Methods Systematic review with narrative synthesis. Studies were identified from structured searches of 19 electronic databases from inception to February 2008; hand searching of bibliographies; Advisory Group members helped identify additional sources. Inclusion criteria: controlled studies of interventions intended to increase breastfeeding/feeding with breastmilk that reported breastmilk feeding outcomes and included infants admitted to neonatal units, their mothers, families and caregivers. Data were extracted and appraised for quality using standard processes. Study selection, data extraction and quality assessment were independently checked. Study heterogeneity prevented meta-analysis. Results Forty-eight studies were identified, mainly measuring short-term outcomes of single interventions in stable infants. We report here a sub-set of 21 studies addressing interventions tested in at least one good-quality or more than one moderate-quality study. Effective interventions identified included kangaroo skin-to-skin contact, simultaneous milk expression, peer support in hospital and community, multidisciplinary staff training, and Unicef Baby Friendly accreditation of the associated maternity hospital. Conclusions Breastfeeding/breastmilk feeding is promoted by close, continuing skin-to-skin contact between mother and infant, effective breastmilk expression, peer support in hospital and community, and staff training. Evidence gaps include health outcomes and costs of intervening with less clinically stable infants, and maternal health and well-being. Effects of public health and policy interventions and the organization of neonatal services remain unclear. Infant feeding in neonatal units should be included in public health surveillance and policy development; relevant definitions are proposed. [source] A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 yearsCLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2004III. Conventional FPDs Abstract: The present study was done to determine the long-term success and survival of fixed partial dentures (FPDs) and to evaluate the risks for failures due to specific biological and technical complications. A MEDLINE search (PubMed) from 1966 up to March 2004 was conducted, as well as hand searching of bibliographies from relevant articles. Nineteen studies from an initial yield of 3658 titles were finally selected and data were extracted independently by three reviewers. Prospective and retrospective cohort studies with a mean follow-up time of at least 5 years in which patients had been examined clinically at the follow-up visits were included in the meta-analysis. Publications only based on patients records, questionnaires or interviews were excluded. Survival of the FPDs was analyzed according to in situ and intact failure risks. Specific biological and technical complications such as caries, loss of vitality and periodontal disease recurrence as well as loss of retention, loss of vitality, tooth and material fractures were also analyzed. The 10-year probability of survival for fixed partial dentures was 89.1% (95% confidence interval (CI): 81,93.8%) while the probability of success was 71.1% (95% CI: 47.7,85.2%). The 10-year risk for caries and periodontitis leading to FPD loss was 2.6% and 0.7%, respectively. The 10-year risk for loss of retention was 6.4%, for abutment fracture 2.1% and for material fractures 3.2%. Résumé L'étude présente a été effectuée pour déterminer le succès à long terme et la survie des prothèses fixées et d'évaluer les risques d'échecs dûà des complications biologiques et techniques. Une recherche Medline de 1966 à mars 2004 a été effectuée ainsi que manuelle pour les bibliographies des articles pouvant répondre à cette question. Dix-neuf études ont été tirées à partir de 3 658 titres et les données ont été extraites indépendamment par deux personnes. Les études prospectives et rétrospectives avec un temps de suivi de minimum cinq années dans lesquelles les patients avaient été examinés cliniquement lors du suivi ont été incluses dans cette méta-analyse. Les publications uniquement basées sur les dossiers des patients, les questionnaires et les interviews ont été exclues. La survie des prothèses a été analysée suivant les risques d'échec et de succès in situ. Des complications techniques et biologiques spécifiques telle que les caries, la perte de vitalité et la réapparition de la maladie parodontale ainsi que la perte de rétention, la perte de vitalité, les fractures dentaires et de matériaux ont également été analysées. La survie à 10 ans pour les prothèses fixées était de 89,1% (intervalle de confiance de 95% : 81,0 à 93,8%) tandis que le succès était de 71,1% (52,2 à 83,6%). Le risque à dix ans pour des caries ou de la parodontite entraînant la perte de la prothèse était respectivement de 2,6 et 0,7%. Le risque à dix années pour la perte de rétention était de 6,4%, de fracture du pilier de 2,1% et de fracture de matériaux de 3,2%. Zusammenfassung Die vorliegende Studie wurde unternommen, um die Langzeiterfolgs- und Ueberlebensraten von festsitzenden Brückenrekonstruktionen (FPDs) zu bestimmen und die Risiken für Misserfolge aufgrund spezifischer biologischer und technischer Komplikationen auszuwerten. Es wurde eine Medline Suche (PubMed) über einen Zeitraum von 1966 bis März 2004 durchgeführt und die Bibliographien von relevanten Artikeln wurden manuell durchsucht. Von einer anfänglichen Auswahl von 3658 Artikeln wurden schlussendlich 19 ausgewählt und die Daten wurden von drei Rezensenten unabhängig herausgelesen. Es wurden prospektive und retrospektive Kohorten-Studien mit einer mittleren Beobachtungszeit von mindestens 5 Jahren, in welchen Patienten klinisch nachuntersucht worden waren, in die Meta-Analyse einbezogen. Publikationen, welche nur auf Einträgen in Krankengeschichten, Fragebogen oder Interviews basierten, wurden ausgeschlossen. Das Ueberleben der FPDs wurde entsprechend des in situ und intakten Misserfolgsrisikos analysiert. Spezifische biologische und technische Komplikationen wie Karies, Vitalitätsverlust und das Auftreten von Parodontalproblemen sowie Retentionsverlust, Zahn- und Materialfrakturen wurden ebenfalls analysiert. Die Ueberlebensrate von festsitzenden Brückenrekonstruktionen über 10 Jahre betrug 89.1% (95% Vertrauensintervall (CI): 81,93.8%), während die Erfolgsrate 71.1% betrug (95% CI: 52.2,83.6%). Das 10-Jahres Risiko für Karies und Parodontitis, welche zum Verlust der FPD führen, betrug 2.6% bzw. 0.7%. Das 10-Jahres Risiko für Retentionsverlust betrug 6.4%, für die Pfeilerfrakturen 2.1% und für Materialfrakturen 3.2%. Resumen El presente estudio se llevó a cabo para determinar el éxito y supervivencia a largo plazo de dentaduras fijas parciales (FPDs) y evaluar los riesgos de fracasos debido a complicaciones biológicas y técnicas específicas. Se llevó a cabo una búsqueda por Medline (PubMed) desde 1996 hasta Marzo de 2004 al igual que una búsqueda a mano de bibliografías de artículos relevantes. Finalmente se seleccionaron diecinueve artículos de una cantidad inicial de 3,658 títulos y se extrajeron los datos independientemente por tres revisores. Se incluyeron en este meta-análisis estudios cohorte prospectivos y retrospectivos con un tiempo de seguimiento medio de 5 años en los que los pacientes se examinaron clínicamente en las visitas de mantenimiento. Se excluyeron publicaciones basadas solamente en las fichas de los pacientes, cuestionarios o entrevistas. Se analizó la supervivencia de los FPDs de acuerdo con los riesgos de fracaso in situ e intacto. También se analizaron las complicaciones biológicas específicas tales como caries, pérdida de vitalidad y recurrencia de enfermedad periodontal al igual que la pérdida de retención, pérdida de vitalidad, fracturas dentales y del material. La supervivencia a los diez años para las dentaduras parciales fijas fue del 89.1% (95% intervalo de confianza (CI): 81,93.8%) mientras que el éxito fue del 71.1% (95% CI: 52.2,83.6%). El riesgo de caries a los 10 años y periodontitis que condujo a la pérdida del FPD fue del 2.6% y del 0.7% respectivamente. El riesgo de pérdida de retención a los 10 años fue del 6.4%, para la fractura del pilar del 2.1% y para la fractura del material del 3.2%. [source] | ||||||||||