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Only Trials (only + trials)
Selected AbstractsInterventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Cindy Stern BHS(Hons) Abstract Aim, Falls can cause serious physical and emotional injuries to patients leading to poor quality of life and increased length of hospital stay. The aim of this study was to present the best available evidence regarding the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls. Methods, A systematic review of randomised controlled trials was undertaken to determine the effectiveness of interventions that were designed to reduce the incidence of falls in older acute-care patients. Only trials published between 1998 and 2008 were considered. Results, Only seven studies were included in the review, indicating the evidence on this topic is sparse. There is some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients: ,,A multidisciplinary multifactorial intervention program consisting of falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days ,,A one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ,,A targeted fall risk factor reduction intervention that includes a fall risk factor screen, recommended interventions encompassing local advice and a summary of the evidence There is also some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications, can reduce the amount of falls in patients following surgery for femoral neck fracture. Conclusion, There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high-quality research is needed in order to ascertain effective fall-prevention strategies in acute-care facilities. [source] Exercise parameters in the treatment of clinical depression: a systematic review of randomized controlled trialsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2010Luke G. Perraton BPT MPT Abstract Rationale, aims and objectives, Previous systematic reviews have concluded that exercise programmes are effective in the management of clinical depression. The aim of this review was to analyse the parameters of exercise programmes reported in the primary research, in order to provide clinicians with evidence-based recommendations for exercise prescription for clinical depression. Methods, A systematic review of randomized controlled trials was undertaken. Only trials that reported exercise to be effective in treating depression were included and our review was limited to adults. Appropriate databases and reference lists were searched using established keywords. Data relating to the type, intensity, frequency, duration, mode of exercise and mode of application of exercise was extracted and collated. Results, A total of 14 randomized controlled trials were included in this review and from these trials 20 intervention arms were analysed. The majority of trials used an aerobic exercise intervention and were supervised. The most common exercise parameters were 60,80% of maximum heart rate for 30 minutes three times per week for an overall duration of 8 weeks. There is an equal volume of evidence supporting group as opposed to individually completed exercise programmes and no trends were identified which would support one mode of exercise over another. Conclusions, Currently the primary research on this topic supports the use of aerobic exercise which is supervised in some capacity. The current evidence base supports a prescription of three 30-minute sessions per week of aerobic exercise at 60,80% of maximum heart rate for at least 8 weeks. [source] Cisapride treatment for gastro-oesophageal reflux in children: A systematic review of randomized controlled trialsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2000R E Gilbert Abstract: The aim of the systematic review was to determine the effect of cisapride compared with placebo or other non-surgical therapies for the treatment of symptoms of gastro-oesophageal reflux in children. We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Science Citation Index and reference lists for randomized controlled trials which compared cisapride with placebo or other non-surgical therapy in children. We included only trials which reported reflux-related symptoms as an outcome, provided that cisapride was administered orally for at least 1 week. Seven trials (286 children in total) compared cisapride with placebo. Two trials reported good concealment of treatment allocation. The pooled odds ratio for the ,same or worse' symptoms was 0.34 (95%CI 0.10, 1.19). There was substantial heterogeneity between studies (P < 0.00001) and the funnel plot was asymmetrical. Adverse effects (mainly diarrhoea) were not significantly increased with cisapride (pooled odds ratio (OR) 1.80: 0.87, 3.70). The reflux index was significantly reduced in children treated with cisapride (weighted mean difference ,6.49: ,10.13, ,2.85). One study (50 children) compared cisapride with gaviscon plus carobel: the OR for the ,same or worse' symptoms was 3.26 (0.93, 11.38). There was no clear evidence that cisapride reduced symptoms of gastro-oesophageal reflux. As smaller, poorer quality studies were biased in favour of a positive treatment effect, the pooled OR overestimated the potential benefits of cisapride. There was some evidence to suggest that gaviscon plus carobel may be a more effective option than cisapride. [source] Enamel matrix derivative (EmdogainŽ) for periodontal tissue regeneration in intrabony defectsAUSTRALIAN DENTAL JOURNAL, Issue 1 2010M Esposito Background:, Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. Objectives:, To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. Search strategy:, We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomized controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. Selection criteria:, RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow-up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. Main results:, Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had <2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI ,2.74 to ,0.46) at the EMG treated sites. Authors' conclusions:, One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD. Plain language summary:, Enamel matrix derivative (EmdogainŽ) for periodontal tissue regeneration in intrabony defects. Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates about 1 mm more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. Bone substitutes may induce less gum retraction than Emdogain. No serious adverse reactions to Emdogain were reported in trials. [source] | ||||||||||