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Methodological Flaws (methodological + flaw)
Selected AbstractsCardiovascular mortality and morbidity in chronic obstructive pulmonary disease: the impact of bronchodilator treatmentINTERNAL MEDICINE JOURNAL, Issue 2 2010R. Wood-Baker Abstract Chronic obstructive pulmonary disease (COPD) is a substantial health burden. Cardiovascular disease (CVD), the leading cause of death, frequently coexists with COPD, an effect attributed to high individual disease prevalences and shared risk factors. It has long been recognized that COPD, whether stable or during acute exacerbations, is associated with an excess of cardiac arrhythmias. Bronchodilator medications have been implicated in the excess CVD seen in COPD, either as an intrinsic medication effect or related to side-effects. Despite the theory behind increased pro-arrhythmic effects in COPD, the reported results of trials investigating this for inhaled formulations at therapeutic doses are few. Methodological flaws, retrospective analysis and inadequate adjustment for concomitant medications, including short-acting ,relief' bronchodilators and non-respiratory medications with known arrhythmia propensity, mar many of these studies. For most bronchodilators at therapeutic levels in stable COPD, we can be reassured of their safety from current studies. The exception to this is ipratropium bromide, where the current data indicate an association with increased cardiovascular adverse effects. Moreover, there is no proven benefit from combining short-acting beta-agonists with short-acting anticholinergics at high doses in the acute setting, and although this practice is widespread, it is associated with increased cardiovascular risk. [source] Alteration of histological gastritis after cure of Helicobacter pylori infectionALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2002M. Hojo Summary Background : It is still disputed whether gastric atrophy or intestinal metaplasia improves after the cure of Helicobacter pylori infection. Aim : To clarify the histological changes after the cure of H. pylori infection through a literature survey. Methods : Fifty-one selected reports from 1066 relevant articles were reviewed. The extracted data were pooled according to histological parameters of gastritis based on the (updated) Sydney system. Results : Activity improved more rapidly than inflammation. Eleven of 25 reports described significant improvement of atrophy. Atrophy was not improved in one of four studies with a large sample size (> 100 samples) and in two of five studies with a long follow-up period (> 12 months), suggesting that disagreement between the studies was not totally due to sample size or follow-up period. Methodological flaws, such as patient selection, and statistical analysis based on the assumption that atrophy improves continuously and generally in all patients might be responsible for the inconsistent results. Five of 28 studies described significant improvement of intestinal metaplasia. Conclusions : Activity and inflammation were improved after the cure of H. pylori infection. Atrophy did not improve generally among all patients, but improved in certain patients. Improvement of intestinal metaplasia was difficult to analyse due to methodological problems including statistical power. [source] Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorderDEPRESSION AND ANXIETY, Issue 2 2003Deepa N. Nadiga M.D. Abstract Panic disorder is a recurrent and disabling illness. It is believed that Cognitive Behavioral Therapy (CBT) has a long-term protective effect for this disorder. This would offer CBT considerable advantage over medication management of panic disorder, as patients often relapse when they are tapered off their medications. This is a review of the literature about the long-term effectiveness of CBT. We searched for follow-up studies of panic disorder using CBT. Of the 78 citations produced in the initial search, most had major methodological flaws, including ignoring losses to follow-up, not accounting for interval treatment, and unclear reporting. Three papers met strict methodological criteria, and two of these demonstrated a modest protective effect of CBT in panic disorder patients. We make recommendations for well-designed studies involving comparisons of medications and cognitive behavior therapy. Depression and Anxiety 17:58,64, 2003. © 2003 Wiley-Liss, Inc. [source] Cognitive,behavioral treatment for alcohol dependence: a review of evidence for its hypothesized mechanisms of actionADDICTION, Issue 10 2000Jon Morgenstern Objective. This review examined support for the hypothesis that cognitive-behavioral treatment (CBT) for alcohol dependence works through increasing cognitive and behavioral coping skills. Method. Ten studies were identified that examined the hypothesized mechanisms of action of CBT. These studies involved random assignment (or its near equivalent) of participants to CBT and at least one comparison condition. Results. Although numerous analyses of the possible causal links have been conducted to evaluate whether CBT works through increasing coping, the results indicate little support for the hypothesized mechanisms of action of CBT. Conclusions. Research has not yet established why CBT is an effective treatment for alcohol dependence. Negative findings may reflect methodological flaws of prior studies. Alternatively, findings may indicate one or more conceptual assumptions underlying CBT require revision. [source] Positive study of Boswellia serrata for knee osteoarthritis suffers from methodological flawsFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 3 2003Article first published online: 14 JUN 2010 [source] Theoretical and Methodological Problems in Cross-Cultural PsychologyJOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 1 2003Carl Ratner Carl Ratner and Lumei Hui, Theoretical and Methodological Problems in Cross-Cultural Psychology, pp. 67,93. Although cross-cultural psychology has advanced our understanding of cultural aspects of psychology, it is marred by theoretical and methodological flaws. These flaws include misunderstanding cultural issues and the manner in which they bear on psychology; obscuring the relation between biology, culture, and psychology; inadequately defining and measuring cultural factors and psychological phenomena; erroneously analysing data and drawing faulty conclusions about the cultural character of psychology. This article identifies fundamental theoretical and methodological errors that have appeared in prominent cross-cultural psychological research. Suggestions for overcoming them are then outlined. [source] A review of quality assessment of the methodology used in guidelines and systematic reviews on oral mucositisJOURNAL OF CLINICAL NURSING, Issue 1 2009Carin Potting Aims and objectives., The objective of this study was to identify and to assess the quality of evidence-based guidelines and systematic reviews we used in the case of oral mucositis, to apply general quality criteria for the prevention and treatment of oral mucositis in patients receiving chemotherapy, radiotherapy or both. Design., Systematic review. Methods., Literature searches were carried out in several electronic databases and websites. Publications were included if they concerned oral mucositis involving adults treated for cancer and had been published after 1 January 2000. As far as systematic reviews were concerned, the article had to report a search strategy, if the search was minimally conducted in the database PubMed or Medline and the articles included in the review were subjected to some kind of methodological assessment. The Appraisal of Guidelines for Research and Education (AGREE) instrument was used to assess the quality of the guidelines and the Overview Quality Assessment Questionnaire (OQAQ) was used for the quality of systematic reviews. Results., Thirty-one articles met the inclusion criteria of which 11 were guidelines and 20 were systematic reviews. Nine of the 11 guidelines did not explicitly describe how they identified, selected and summarised the available evidence. Reviews suffered from lack of clarity, for instance, in performing a thorough literature search. The quality varied among the different guidelines and reviews. Conclusion., Most guidelines and systematic reviews had serious methodological flaws. Relevance to clinical practice., There is a need to improve the methodological quality of guidelines and systematic reviews for the prevention and treatment of oral mucositis if they are to be used in clinical practice. [source] Intervention studies to reduce the prevalence and incidence of pressure sores: a literature reviewJOURNAL OF CLINICAL NURSING, Issue 2 2000Cert Ed, Dinah Gould BSc, Dip Nurs, MPhil ,,Much has been written about the prevention of pressure sores. However, electronic and manual searches located only 10 studies within the literature in the UK that described interventions able to reduce either their incidence or prevalence. ,,All the studies located contained serious methodological flaws. Apparent success in reducing the number or severity of pressure sores could have resulted because staff involved in data collection were aware that the study was being undertaken and thus took more interest in pressure area care. ,,From the review findings it is apparent that there is a dearth of research evidence upon which to base practice in the sphere of pressure sore prevention and further research is urgently required. [source] Assessment and diagnosis of depression in people with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2003J. A. McBrien Abstract Background Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic. Method The present paper reviews the progress in this field since three reviews, all published in the mid-1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales. Results Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID. Conclusions It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large-scale, collaborative, prospective studies are called for. [source] Systematic review: self-management support interventions for irritable bowel syndromeALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010S. D. Dorn Aliment Pharmacol Ther 2010; 32: 513,521 Summary Background, Irritable bowel syndrome is an extremely common and costly condition. Because there is no cure, patients must be supported to manage their own condition. Aim, To assess systematically the interventions used to support irritable bowel syndrome patient self-management. Methods, A search of PubMed, EMBASE, CINAHL and PsycINFO was performed to identify all studies that involved self-management support interventions for irritable bowel syndrome. Studies that compared the self-management-related intervention to a control group were included. Results, Eleven studies that involved a total of 1657 patients were included. For nearly all studies, the intervention was associated with statistically significant benefits. However, across studies there was significant heterogeneity in terms of sample size, diagnostic criteria, study setting, study design, primary outcome, statistical analyses and study quality. Therefore, individual study results could not be statistically combined. Conclusions, Many self-management support interventions appear benefit patients with irritable bowel syndrome. However, studies were limited by methodological flaws. Furthermore, feasibility in ,real world' clinical practice is uncertain. Thus, practical self-management interventions that can be applied across various clinical settings should be developed, and then tested in well-designed clinical trials. [source] Meta-analysis: deamidated gliadin peptide antibody and tissue transglutaminase antibody compared as screening tests for coeliac diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2010N. R. LEWIS Summary Background, Following the appreciation of the importance of gliadin deamidation in the immunopathogenesis of coeliac disease, diagnostic tests based on antibodies to deamidated gliadin peptides have been developed and shown to have high sensitivity and specificity. Aim, To compare the performance of the deamidated gliadin peptides antibody test with the current standard, the tissue transglutaminase antibody test, through a meta-analysis of published studies. Methods, Databases from 1998 to 2008 were searched for relevant studies. These were assessed for methodological quality and standard statistical tests were applied to compare particularly the sensitivity and specificity of the two tests for the diagnosis of coeliac disease. Results, Most studies had methodological flaws, especially ascertainment bias. The pooled sensitivities for the deamidated gliadin peptides antibody and tissue transglutaminase antibody tests were 87.8% (95% CI, 85.6,89.9) and 93.0% (95% CI, 91.2,94.5) respectively and the pooled specificities were 94.1% (95% CI, 92.5,95.5) and 96.5% (95% CI, 95.2,97.5) respectively. Conclusion, Although both tests perform well, the tissue transglutaminase antibody test outperforms the deamidated gliadin peptides antibody test and remains the preferred serological test for the diagnosis and/or exclusion of coeliac disease. [source] Occupational science: updating the United Kingdom journey of discoveryOCCUPATIONAL THERAPY INTERNATIONAL, Issue 2 2000Catherine R. Mounter Abstract The metaphor of a journey is used to describe the incremental influence of occupational science in the UK. A historical perspective is taken to identify and discuss key concepts and issues. Subjective bias and methodological flaws are acknowledged. Discussion for future directions is contained within contextual orientation. Ongoing debate is invited and encouraged. Copyright © 2000 Whurr Publishers Ltd. [source] Nifedipine trials: effectiveness and safety aspectsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2005Herman P. van Geijn Nifedipine (Adalat) is marketed as an anti-hypertensive agent. Nifedipine inhibits voltage-dependent L-type calcium channels, which leads to vascular (and other) smooth muscle relaxation and negative inotropic and chronotropic effects on the heart. Vasodilation, followed by a baroreceptor-mediated increase in sympathetic tone then results in indirect cardiostimulation. Nifedipine was introduced as a tocolytic agent at a time when ,-agonists and magnesium sulphate dominated the arena for the prevention of preterm birth. The oral administration route, the availability of immediate and slow-release preparations, the low incidence of (mild) side effects, and its limited costs explain the attraction to this medication from the obstetric field and its rapid and widespread distribution. Currently, over 40 studies have been published on nifedipine's tocolytic effectiveness, including seven meta-analyses. The quality of the studies suffers particularly from performance bias because the majority of them failed to ensure adequate blinding to treatment both for providers and patients. Concerns about other methodological flaws include measurements, outcome assessment and attrition bias. In particular, the safety aspects of nifedipine for tocolysis have been underassessed. Conclusions from the meta-analyses, favouring the use of nifedipine as a tocolytic agent, are not supported by close examination of the data. The tocolytic effectiveness and ,safety' of nifedipine has been studied primarily in normal pregnancies. Based on its pharmacological properties, one should be cautious to administer nifedipine when the maternal cardiovascular condition is compromised, such as with intrauterine infection, twin pregnancy, maternal hypertension, cardiac disease, etc. Life-threatening pulmonary oedema and/or cardiac failure are definite risks and have been reported. Under such circumstances, the baroreceptor-mediated increase in sympathetic tone may not balance the cardiac-depressant activity of nifedipine. [source] Les enjeux de la privatisation des établissements de détentionCANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 2 2005Daniel Pelletier Sommaire: Le mouvement de privatisation des prisons et des pénitenciers a connu un développement fdgurant dans les pays anglo-saxons de 1990 à 2000. Depuis, plu-sieurs administrations publiques, en particulier aux États-Unis, ont réalisé que les avantages escomptés et annoncés par les grandes corporations du secteur privé n'étaient pas vraiment au rendez-vous, au point ou on parle actuellement de l'éclate-ment de la bulle de la privatisation. Le débat est aujourd'hui dominé par les positions extrêmes de l'entreprise privée - qui continue à vanter ses établissements - et des associations de défense de droits civiques et des syndicats, qui adoptent la position opposée. L'examen des recherches empiriques ayant été faites à ce sujet révèle que la majorité des études comparatives présentent des failles méthodologiques importantes qui ne permitting pas d'asseoir la prise de décision sur des bases solides. Il importe donc d'agir avec prudence dans ce secteur fortement influencé par des enjeux politiques, sociaux et communicationnels dont l'ampleur reste encore insoupconnée. Abstract: From 1990 to 2000, the trend towards the privatization of jails and penitentiaries in Anglo-Saxon countries grew very rapidly. Since then, several public administrations, particularly in the United States, have come to realize that the benefits anticipated by the big corporations in the sector never actually materialized; in fact, we now talk of the bursting of the privatization bubble. Today, the debate is dominated by the extreme positions taken by private enterprise, which continues to boast about its institutions, and by human and trade-union rights advocacy associations, which are adopting the opposite position. The review of empirical research on this topic indicates that most comparative studies have significant methodological flaws that undermine the foundations of the decision-making process. It is therefore important to act with caution in this sector, which is highly influenced by political, social and communicational issues, the magnitude of which is yet unknown. 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