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Study Quality (study + quality)
Selected AbstractsSchizophrenia and weight management: a systematic review of interventions to control weightACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2003G. Faulkner Objective: Weight gain is a frequent side effect of antipsychotic medication which has serious implications for a patient's health and well being. This study systematically reviews the literature on the effectiveness of interventions designed to control weight gain in schizophrenia. Method: A systematic search strategy was conducted of major databases in addition to citation searches. Study quality was rated. Results: Sixteen studies met the inclusion criteria. Five of eight pharmacological intervention studies reported small reductions in weight (<5% baseline body weight). All behavioural (including diet and/or exercise) interventions reported small reductions in, or maintenance of, weight. Conclusion: Weight loss may be difficult but it is not impossible. Given the inconsistent results, the widespread use of pharmacological interventions cannot be recommended. Both dietary and exercise counselling set within a behavioural modification programme is necessary for sustained weight control. [source] Lower suicide risk with long-term lithium treatment in major affective illness: a meta-analysisACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2001Leonardo Tondo Objective:,To compare suicide rates with vs. without long-term lithium treatment in major affective disorders. Method:,Broad searching yielded 22 studies providing suicide rates during lithium maintenance; 13 also provide rates without such treatment. Study quality was scored, between-study variance tested, and suicide rates on vs. off lithium examined by meta-analyses using random-effects regression methods to model risk ratios. Results:,Among 5647 patients (33,473 patient-years of risk) in 22 studies, suicide was 82% less frequent during lithium-treatment (0.159 vs. 0.875 deaths/100 patient-years). The computed risk-ratio in studies with rates on/off lithium was 8.85 (95% CI, 4.12,19.1; P<0.0001). Higher rates off-lithium were not accounted for by treatment-discontinuation. Conclusion:,Suicide risk was consistently lower during long-term treatment of major affective illnesses with lithium in all studies in the meta-analysis, including the few involving treatment-randomization. [source] Brief screening questionnaires to identify problem drinking during pregnancy: a systematic reviewADDICTION, Issue 4 2010Ethel Burns ABSTRACT Aims Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. Methods Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect ,at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. Results Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71,91%) and AUDIT-C (95%), with high specificity (71,89%, 73,83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score ,3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score ,8 performed poorly. Conclusion T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted. [source] How effective is outpatient care compared to inpatient care for the treatment of anorexia nervosa? a systematic reviewEUROPEAN EATING DISORDERS REVIEW, Issue 4 2001Catherine Meads Abstract Objective: To review systematically inpatient compared to outpatient care for the treatment of anorexia nervosa and other eating disorders. Method: Search of electronic databases, references and contact with experts to identify randomized controlled trials (RCTs), case,control studies and case series. Study quality was assessed and data extracted by two independent researchers. Results: Two RCTs and seven case series were identified. Unpublished 5-year follow-up data from one RCT showed a (non-statistically significant) improvement in percentage well in the outpatient compared to the inpatient group, but no difference in mortality. Case series were difficult to interpret because of the inherent biases , follow-up varied from 1.5 to 11.7 years and showed wide variations in outcome. Discussion: There is no evidence that inpatient treatment is more (or less) effective than outpatient treatment for people with anorexia nervosa in the long term. Short-term emergency inpatient treatment of the consequences of eating disorders may still be necessary. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Research to practice: Effectiveness of controlled workplace interventions to reduce musculoskeletal disorders in the manufacturing environment,critical appraisal and meta-analysisHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 2 2008Setenay Tuncel Previous studies on the effectiveness of interventions in reducing musculoskeletal disorders (MSD) in manufacturing facilities had contradictory results, indicating a need for a quality assessment of these studies followed by a quantitative assessment of the overall effectiveness of the interventions. These assessments may also provide suggestions for practical implementations. The first objective of this study is to assess the effectiveness of controlled workplace interventions to reduce the occurrence of MSD in the manufacturing environment by utilizing meta-analysis integrated with the study quality score. The second objective is to translate the research findings into practical guidelines. Two hypotheses were tested pertinent to the first objective: (1) Controlled workplace interventions are effective in reducing the occurrence of MSD in different body regions among manufacturing workers and (2) the study quality scores do not depend on the evaluator. The study quality was assessed for all articles, however, meta effect size (meta-OR) was calculated only for the articles that reported prevalence of low back disorders (LBDs), using the Mantel,Haenszel method. The effect of study quality was included into meta-OR. The chi-square test of independence was employed to test the second hypothesis. Seven articles were identified. Study quality was poor (0.39 out of 2) to moderate (0.97). Insignificant reduction in LBDs prevalence (meta-OR = 0.925; 95% CI: 0.566,1.512) was found. Integration of the study quality did not have a substantial effect on the meta-OR (meta-OR = 0.933; 95% CI: 0.571,1.525). Each evaluator's study quality scores were not independent from the agreed quality scores (p < 0.01). The results suggested that practitioners should consider scientific evidence during design and implementation of an intervention, especially in terms of study duration, confounders, outcome measures, and data analysis. The articles reviewed exhibited the following: (1) the statistical insignificance of the meta-OR; (2) the relatively low methodological quality of studies; and (3) the small number of studies included in the meta-OR. The extent of the generalizability of meta-OR for LBD to other body regions was also in question. Future research should consider the following: (1) the physical and nonphysical work environment should be assessed to determine the workplace-specific needs, and the intervention should be structured around these needs; (2) group comparability, participation rate, subject loss, and randomization of subjects should be taken into account; (3) exposure and outcome measurement methods should be reported, as well as blinding of the observers and subjects, when applicable, to ensure reliability and validity; and (4) data analysis should be conducted adjusting for covariates and confounders, different lengths of follow-up, and level of exposure. © 2008 Wiley Periodicals, Inc. [source] Improving Child Protection in the Emergency Department: A Systematic Review of Professional Interventions for Health Care ProvidersACADEMIC EMERGENCY MEDICINE, Issue 2 2010Amanda 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 Efficacy of Acamprosate in the Maintenance of Abstinence in Alcohol-Dependent Individuals: Results of a Meta-AnalysisALCOHOLISM, Issue 1 2004Karl Mann Abstract: Background: A number of clinical trials have been undertaken to determine the efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals. However, the reported differences in patient populations, treatment duration, and study endpoints make comparisons difficult. An assessment of the efficacy of treatment with acamprosate was, therefore, undertaken using meta-analytical techniques. Methods: All randomized, placebo-controlled trials (RCTs) that fulfilled predetermined criteria were identified using (1) a language unrestricted search of 10 electronic databases; (2) a manual search of relevant journals, symposia, and conference proceedings; (3) cross-referencing of all identified publications; (4) personal communications with investigators; and (5) scrutiny of Merck-Santé's internal reports of all European trials. Study quality was assessed, independently, by three blinded workers. Key outcome data were identified; some outcome variables were recalculated to ensure consistency across trials. The primary outcome measure was continuous abstinence at 6 months; abstinence rates were determined by estimating Relative Benefit (RB). Results: A total of 19 published 1 unpublished RCTs were identified that fulfilled the selection criteria; 3 were excluded because the documentation available was insufficient to allow adequate assessment. The remaining 17 studies, which included 4087 individuals, 53% of whom received active drug, were of good quality and were otherwise reasonably comparable. There was no evidence of publication bias. Continuous abstinence rates at 6 months were significantly higher in the acamprosate-treated patients (acamprosate, 36.1%; placebo, 23.4%; RB, 1.47; [95% confidence intervals (CI): 1.29,1.69]; p < 0.001). This effect was observed independently of the method used for assigning missing data. The effect sizes in abstinent rates at 3, 6, and 12 months were 1.33, 1.50, and 1.95, respectively. At 12 months, the overall pooled difference in success rates between acamprosate and placebo was 13.3% (95% CI, 7.8,18.7%; number needed to treat, 7.5). Acamprosate also had a modest but significant beneficial effect on retention (6.01%; [95% CI, 2.90,8.82]; p= 0.0106). Conclusion:: Acamprosate has a significant beneficial effect in enhancing abstinence in recently detoxified, alcohol-dependent individuals. [source] Meta-analysis: the efficacy of azathioprine and mercaptopurine in ulcerative colitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009J. P. GISBERT Summary Background, Debate exists regarding to whether thiopurine therapy is as effective in ulcerative colitis (UC) as it is in Crohn's disease. Aim, To review systematically the efficacy of azathioprine (AZA) and mercaptopurine (MP) in UC, and to conduct a meta-analysis of randomized clinical trials evaluating the efficacy of AZA/MP for the induction or maintenance of UC clinical remission. Methods,Selection of studies: Evaluating AZA/MP for induction and/or maintenance of clinical remission of UC. Randomized-controlled-trials comparing AZA/MP with placebo/5-aminosalicylates were included in the meta-analysis. Search strategy: Electronic and manual. Study quality: Independently assessed by two reviewers. Data synthesis: By ,intention-to-treat'. Results, Thirty noncontrolled studies (1632 patients) were included in the systematic review. Mean efficacy of AZA/MP was 65% for induction and 76% for maintenance of the remission. Seven controlled studies were included in the meta-analysis. (i) Induction of remission: four studies (89 AZA/MP-treated patients) showed mean efficacy of 73% vs. 64% in controls (OR = 1.59; 95% CI = 0.59,4.29). (ii) Maintenance of remission: six studies (124 AZA/MP-treated patients) showed mean efficacy of 60% vs. 37% in controls (OR = 2.56; 95% CI = 1.51,4.34). When only studies comparing AZA/MP vs. placebo were considered, OR was 2.59 (95% CI = 1.26,5.3), absolute risk reduction was 23% and number-needed-to-treat (NNT) to prevent one recurrence was 5. Conclusion, Thiopurine drugs (AZA/MP) are more effective than placebo for the prevention of relapse in UC, with an NNT of 5 and an absolute risk reduction of 23%. [source] The Effect of Emergency Department Crowding on Clinically Oriented OutcomesACADEMIC EMERGENCY MEDICINE, Issue 1 2009Steven L. Bernstein MD Abstract Background:, An Institute of Medicine (IOM) report defines six domains of quality of care: safety, patient-centeredness, timeliness, efficiency, effectiveness, and equity. The effect of emergency department (ED) crowding on these domains of quality has not been comprehensively evaluated. Objectives:, The objective was to review the medical literature addressing the effects of ED crowding on clinically oriented outcomes (COOs). Methods:, We reviewed the English-language literature for the years 1989,2007 for case series, cohort studies, and clinical trials addressing crowding's effects on COOs. Keywords searched included "ED crowding,""ED overcrowding,""mortality,""time to treatment,""patient satisfaction,""quality of care," and others. Results:, A total of 369 articles were identified, of which 41 were kept for inclusion. Study quality was modest; most articles reflected observational work performed at a single institution. There were no randomized controlled trials. ED crowding is associated with an increased risk of in-hospital mortality, longer times to treatment for patients with pneumonia or acute pain, and a higher probability of leaving the ED against medical advice or without being seen. Crowding is not associated with delays in reperfusion for patients with ST-elevation myocardial infarction. Insufficient data were available to draw conclusions on crowding's effects on patient satisfaction and other quality endpoints. Conclusions:, A growing body of data suggests that ED crowding is associated both with objective clinical endpoints, such as mortality, as well as clinically important processes of care, such as time to treatment for patients with time-sensitive conditions such as pneumonia. At least two domains of quality of care, safety and timeliness, are compromised by ED crowding. [source] Child sexual abuse in the etiology of depression: A systematic review of reviewsDEPRESSION AND ANXIETY, Issue 7 2010Roberto Maniglio Psy.D. Ph.D. Abstract Background: Despite a large amount of research, there is considerable controversy about the role that child sexual abuse plays in the etiology of depression. To prevent interpretative difficulties, mistaken beliefs, or confusion among professionals who turn to this literature for guidance, this article addresses the best available scientific evidence on the topic, by providing a systematic review of the several reviews that have investigated the literature on the issue. Methods: Seven databases were searched, supplemented with hand search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus. Results: Four reviews, including about 60,000 subjects from 160 studies and having no limitations that could invalidate their results, were analyzed. There is evidence that child sexual abuse is a significant, although general and nonspecific, risk factor for depression. The relationship ranges from small-to-medium in magnitude and is moderated by sample source. Additional variables may either act independently to promote depression in people with a history of sexual abuse or interact with such traumatic experience to increase the likelihood of depression in child abuse survivors. Conclusions: For all victims of abuse, programs should focus not only on treating symptoms, but also on reducing additional risk factors. Depressed adults who seek psychiatric treatment should be enquired about early abuse within admission procedures. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source] Severe mental illness and criminal victimization: a systematic reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009R. Maniglio Objective:, To estimate the prevalence of criminal victimization among people with severe mental illness and to explore risk factors. Method:, Four databases (MEDLINE, ScienceDirect, ERIC, and AMED) were searched for articles published between January 1966 and August 2007, supplemented with hand-search of reference lists from retrieved papers. The author and a Medical Doctor independently abstracted data and assessed study quality. Disagreements were resolved by consensus after review of the article and the review protocol. Results:, Nine studies, including 5195 patients, were identified. Prevalence estimates of criminal victimization ranged from 4.3% to 35.04%. Rates of victimization among severely mentally ill persons were 2.3,140.4 times higher than those in the general population. Criminal victimization was most frequently associated with alcohol and/or illicit drug use/abuse, homelessness, more severe symptomatology, and engagement in criminal activity. Conclusion:, Prevention and intervention programs should target high-risk groups and improve patients' mental health and quality of life. [source] Administrative registers in psychiatric research: a systematic review of validity studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2005N. Byrne Objective:, To conduct a systematic review of studies investigating the validity of administrative registers for use in psychiatric research. Method:, Studies were identified using MEDLINE (1966,2004) and EMBASE (1980,2004) databases using keywords ,validity' or ,reliability' combined with ,register' or ,database$'. Studies reviewed by two raters blind to each other and quality assessed using a data extraction form devised by the authors. A narrative description of the findings is presented. Results:, Fourteen studies were identified, seven of which concerned Scandinavian registers. Ten studies were solely concerned with diagnostic validity and the most common single diagnosis studied was schizophrenia (five studies). Methods used and study quality varied widely. Conclusion:, Given the importance of the area, relatively little high-quality work exists into systematically measuring the diagnostic data validity of registers for research purposes. [source] Effectiveness of Corticosteroid Treatment in Acute Pharyngitis: A Systematic Review of the LiteratureACADEMIC EMERGENCY MEDICINE, Issue 5 2010Andrew 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] Research to practice: Effectiveness of controlled workplace interventions to reduce musculoskeletal disorders in the manufacturing environment,critical appraisal and meta-analysisHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 2 2008Setenay Tuncel Previous studies on the effectiveness of interventions in reducing musculoskeletal disorders (MSD) in manufacturing facilities had contradictory results, indicating a need for a quality assessment of these studies followed by a quantitative assessment of the overall effectiveness of the interventions. These assessments may also provide suggestions for practical implementations. The first objective of this study is to assess the effectiveness of controlled workplace interventions to reduce the occurrence of MSD in the manufacturing environment by utilizing meta-analysis integrated with the study quality score. The second objective is to translate the research findings into practical guidelines. Two hypotheses were tested pertinent to the first objective: (1) Controlled workplace interventions are effective in reducing the occurrence of MSD in different body regions among manufacturing workers and (2) the study quality scores do not depend on the evaluator. The study quality was assessed for all articles, however, meta effect size (meta-OR) was calculated only for the articles that reported prevalence of low back disorders (LBDs), using the Mantel,Haenszel method. The effect of study quality was included into meta-OR. The chi-square test of independence was employed to test the second hypothesis. Seven articles were identified. Study quality was poor (0.39 out of 2) to moderate (0.97). Insignificant reduction in LBDs prevalence (meta-OR = 0.925; 95% CI: 0.566,1.512) was found. Integration of the study quality did not have a substantial effect on the meta-OR (meta-OR = 0.933; 95% CI: 0.571,1.525). Each evaluator's study quality scores were not independent from the agreed quality scores (p < 0.01). The results suggested that practitioners should consider scientific evidence during design and implementation of an intervention, especially in terms of study duration, confounders, outcome measures, and data analysis. The articles reviewed exhibited the following: (1) the statistical insignificance of the meta-OR; (2) the relatively low methodological quality of studies; and (3) the small number of studies included in the meta-OR. The extent of the generalizability of meta-OR for LBD to other body regions was also in question. Future research should consider the following: (1) the physical and nonphysical work environment should be assessed to determine the workplace-specific needs, and the intervention should be structured around these needs; (2) group comparability, participation rate, subject loss, and randomization of subjects should be taken into account; (3) exposure and outcome measurement methods should be reported, as well as blinding of the observers and subjects, when applicable, to ensure reliability and validity; and (4) data analysis should be conducted adjusting for covariates and confounders, different lengths of follow-up, and level of exposure. © 2008 Wiley Periodicals, Inc. [source] Minimising undernutrition in the older inpatientINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2007Dawn Vanderkroft BSc internshipNutr&Diet APD Abstract Background, Malnutrition among elderly hospitalised patients is widespread and has been shown to lead to adverse health outcomes. The effectiveness of interventions to minimise undernutrition in elderly inpatients is not well documented. Objectives, To identify the best available practices, in the hospital setting, that minimise undernutrition or the risk of undernutrition, in the acute care patient especially for the older patient. The review will assesses the effectiveness of a range of interventions designed to promote adequate nutritional intake in the acute care setting, with the aim of determining what practices minimise malnutrition in the elderly inpatients. Search strategy, English language articles from 1980 onwards were sought using Medline, Premedline, Cinahl, Austrom-Australasian Medical Index and AustHealth, Embase and Science Citations Index. Selection criteria, For inclusion the study had to include an intervention aiming to minimise undernutrition in hospitalised elderly patients aged 65 years or older. All study designs were included. Data collection and analysis, Two independent reviewers assessed the eligibility of each study for inclusion into the review, critically appraised the study quality and extracted data using standardised tools. For each outcome measure results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta-analyses where appropriate. Main results, Twenty-nine studies met the inclusion criteria, with a total of 4021 participants. The focus of 15 interventions was the supplying of oral supplements to the participants, six focused on enteral nutrition therapy, four interventions made changes to the foods provided as part of the hospital diet, one included the services of an additional staff member and three incorporated the implementation of evidence-based guidelines. Ten meta-analyses were conducted from which the main findings were: significant improvements in weight status and arm muscle circumferences with an oral supplement intervention, P < 0.05. Reviewers' conclusions, The findings of the review support the use of oral supplements to minimise undernutrition in elderly inpatients. The results also emphasise the need for more high-quality research using appropriate outcome measures in the area of minimisation of undernutrition, particularly interventions that make alterations to the hospital diet and address support for feeding patients at the ward level. [source] Fall risk factors in older people with dementia or cognitive impairment: a systematic reviewJOURNAL OF ADVANCED NURSING, Issue 5 2009Jürgen Härlein Abstract Title.,Fall risk factors in older people with dementia or cognitive impairment: a systematic review. Aim., This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case,control studies. Background., People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies. Data sources., The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007. Review methods., A systematic review was conducted. Cohort or case,control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality. Results., Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density. Conclusion., There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed. [source] A systematic review of prophylactic antimicrobials in PEG placementJOURNAL OF CLINICAL NURSING, Issue 7 2009Allyson Lipp Aim., To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies. Background., Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement. Design., Systematic review. Methods., We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. Results., Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0·31, 95% CI 0·22,0·44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5·8 patients to prevent one infection , NNT. Conclusions., Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection. Relevance to clinical practice., The nurse's role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement. [source] Meta-analysis of the effects of respiratory rehabilitation programmes on exercise capacity in accordance with programme characteristicsJOURNAL OF CLINICAL NURSING, Issue 1 2007HyunSoo Oh PhD Aims and objectives., This study was performed to investigate the effects of respiratory rehabilitation programmes on exercise capacity in terms of the programme type, the protocol used and other programme characteristics. Background., As the suitable rehabilitation programmes have not been specified, diverse programmes are provided in clinics. Design., Meta-analysis of the primary study results Methods., A computerized search through MEDLINE and CINHAL in addition to tracking down references cited in bibliographies of primarily searched studies were performed to obtain sample studies. Finally 19 research reports were examined. Results., The results of meta-regression showed that the combined effect size of the programmes on exercise capacity was unaffected by forced expiratory volume (in one second), age, the duration and frequency of the programme, or study quality. In addition, the results of meta- anova indicated that the combined effect size was not affected by (i) whether a programme was hospital based or not, (ii) whether a programme was lower-extremity or combined low- and upper-extremity exercise training, (iii) measurement time, and (iv) exercise intensity. Conclusions., The effects of programmes on exercise capacity were not differed in terms of the places where rehabilitation programmes were applied, programme content, measurement time, exercise target sites of body, and the duration and frequency of the programme. Relevance to clinical practice., The results of the present study can provide objective data when constructed or applied on a respiratory rehabilitation programme in clinics. [source] Effect of hospitalist attending physicians on trainee educational experiences: A systematic review,JOURNAL OF HOSPITAL MEDICINE, Issue 8 2009Pradeep Natarajan MD Abstract BACKGROUND: Trainees receive much of their inpatient education from hospitalists. PURPOSE: To characterize the effects of hospitalists on trainee education. DATA SOURCES: MEDLINE, Database of Reviews of Effectiveness (DARE), National Health Service (NHS) Economic Evaluation Database (EED), Health Technology Assessment (HTA), and the Cochrane Collaboration Database (last searched October 2008) databases using the term "hospitalist", and meeting abstracts from the Society of Hospital Medicine (SHM) (2002-2007), Society of General Internal Medicine (SGIM) (2001-2007), and Pediatric Academic Societies (PAS) (2000-2007). STUDY SELECTION: Original English language research studies meeting all of the following: involvement of hospitalists; comparison to nonhospitalist attendings; evaluation of trainee knowledge, skills, or attitudes. 711 articles were reviewed, 32 retrieved, and 6 included; 7,062 meeting abstracts were reviewed, 9 retrieved, and 2 included. DATA EXTRACTION: Two authors reviewed articles to determine study eligibility. Three authors independently reviewed included articles to abstract data elements and classify study quality. DATA SYNTHESIS: Seven studies were quasirandomized one was a noncontemporaneous comparison. All citations only measured trainee attitudes. In all studies comparing hospitalists to nonhospitalists, trainees were more satisfied with hospitalists overall, and with other aspects of their teaching, but ratings were high for both groups. One of 2 studies that distinguished nonhospitalist general internists from specialists showed that trainees preferred hospitalists, but the other did not demonstrate a hospitalist advantage over general internists. CONCLUSIONS: Trainees are more satisfied with inpatient education from hospitalists. Whether the increased satisfaction translates to improved learning is unclear. Journal of Hospital Medicine 2009;4:490,498. © 2009 Society of Hospital Medicine. [source] Effects of rapid response systems on clinical outcomes: Systematic review and meta-analysisJOURNAL OF HOSPITAL MEDICINE, Issue 6 2007Sumant R. Ranji MD Abstract BACKGROUND A rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster-randomized trial. PURPOSE To evaluate the effects of RRSs on clinical outcomes through a systematic literature review. DATA SOURCES MEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies. STUDY SELECTION Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions. DATA EXTRACTION Two authors independently determined study eligibility, abstracted data, and classified study quality. DATA SYNTHESIS Thirteen studies met inclusion criteria: 1 cluster-randomized controlled trial (RCT), 1 interrupted time series, and 11 before-after studies. The RCT showed no effects on any clinical outcome. Before-after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74-0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65-0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before-after studies. CONCLUSIONS Published studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before-after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422,432. © 2007 Society of Hospital Medicine. [source] Treatment of Hypertriglyceridemia With Omega-3 Fatty Acids: A Systematic ReviewJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2004Amanda 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] A systematic review of psychological interventions for children with asthmaPEDIATRIC PULMONOLOGY, Issue 2 2007Grad., Janelle Yorke MSc Abstract Aim: Psychological factors may influence the symptoms and management of asthma in children in many ways. It is, therefore, suggested that psychological interventions may be appropriate for this population. This paper reports a systematic review assessing the efficacy of psychological interventions in improving health outcomes for children with asthma. Methodology: A review of Randomized Controlled Trials (RCT) was designed. RCTs assessing the effects of a psychological intervention in child participants were included in the review. Outcome measures included healthcare utilization, lung function, asthma symptoms, and psychological health status. The search was conducted until April 2005. Results: Twelve studies, involving 588 children, were included in the review; however, study quality was poor and sample sizes were frequently small. A meta-analysis was performed on two studies, examining the effects of relaxation therapy on PEFR which favored the treatment group (SD 0.82, CI 0.41,1.24). No other meta-analysis could be performed due to the diversity of interventions and the outcomes assessed. In addition, many studies reported insufficient data. Conclusions: This review was unable to draw firm conclusions for the role of psychological interventions for children with asthma. We recommend that valid outcome measures for evaluating the effectiveness of psychological interventions for children with asthma need to address adjustment to and coping with asthma, as well as other psychological indicators. The absence of an adequate evidence base is demonstrated, highlighting the need for well-conducted RCTs in this area. Pediatr Pulmonol. 2007; 42:114,124. © 2006 Wiley-Liss, Inc. [source] The impact of personality disorders on treatment outcome in bipolar disorder: A reviewPERSONALITY AND MENTAL HEALTH, Issue 1 2007Peter J. Bieling Bipolar disorder (BD) is a chronic psychiatric illness for which there are a number of efficacious and effective treatments. However, for many sufferers recovery is incomplete or tenuous. Factors associated with poor outcomes in the disorder are of special interest, and comorbidity of BD with personality disorder (PD) has been proposed as a possible predictor of poor outcome. We reviewed available studies (n = 12) in the literature that specifically assessed the impact of personality psychopathology on illness outcomes in BD including functioning, response to treatment and suicidality. Quality of methodology, assessment methods and number of participants in studies were highly variable. Despite these variations in study quality, the presence of a PD was robustly associated (usually medium size effects) with a worse outcome in BD. Patients with BD and a diagnosis of PD are more likely to be hospitalized, require more time to achieve symptom stabilization, have more chronic impairments in occupational and social functioning, are less compliant to medication, have greater levels of suicidality and utilize more psychiatric services than patients with BD alone. The implications of these findings for further research and clinical care in BD are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Psychosocial interventions and quality of life in gynaecological cancer patients: a systematic reviewPSYCHO-ONCOLOGY, Issue 8 2009Jolyn Hersch Abstract Objective: Women with gynaecological cancer are at risk of poor quality of life outcomes. Although various psychosocial interventions have been developed to address these concerns, such interventions have not yet been systematically evaluated in this population. The current review provides an up-to-date and comprehensive summary of the evidence regarding the effectiveness of psychosocial interventions in women with gynaecological cancers. Methods: Relevant studies were identified via Medline, CINAHL, and PsycINFO databases (1980 to June 2008), reference lists of articles and reviews, grey literature databases, and consultations with physicians and other experts in the field. Only controlled trials comparing a psychosocial intervention with a control group in a gynaecological cancer population, with at least one quality of life variable as a main outcome, were included in the review. Two authors independently assessed trial quality and extracted data. Results: Twenty-two studies involving 1926 participants were included. There was substantial variability in study quality and results. Evidence was mixed regarding intervention effects on social and sexual functioning, distress, depression, anxiety, attitude to medical care, self-esteem and body image. Interventions generally did not improve physical or vocational outcomes. Conclusions: There was limited evidence in support of healing touch, whereas information-based interventions seemed largely unable to provide meaningful benefits. Cognitive-behavioural interventions had some positive effects. Counselling appeared to be the most promising intervention strategy for addressing quality of life concerns for women with gynaecological cancers. Copyright © 2008 John Wiley & Sons, Ltd. [source] Prevalence of viral infection detected by PCR and RT-PCR in patients with acute exacerbation of COPD: A systematic reviewRESPIROLOGY, Issue 3 2010Anant MOHAN ABSTRACT Background and objective: Viruses are important aetiological agents of acute exacerbation of COPD (AECOPD). Their reported prevalence varies from region to region. This systematic review calculated the prevalence of respiratory viral infections in AECOPD. Methods: A systematic search was performed using Medline, and references of relevant articles and conference proceedings were hand searched. Articles for review were selected based on the following criteria: (i) prospective or cross-sectional study, (ii) original research, (iii) viral detection used the highly sensitive techniques of PCR and/or Reverse Transcriptase PCR (RT-PCR), (iv) viral prevalence in AECOPD defined, and (v) full paper available in English. We assessed the study quality and extracted data independently and in duplicate using a pre-defined data extraction form. Weighted mean prevalence (WMP) was calculated and a forest plot was constructed to show the dispersion. Results: Eight studies met the inclusion criteria. The WMP of respiratory viral infection in AECOPD was 34.1% (95% CI: 23.9,44.4). picornavirus was the most commonly detected virus with WMP 17.3% (95% CI: 7.2,27.3), followed by influenza; 7.4% (95% CI: 2.9,12.0), respiratory syncytial virus; 5.3% (95% CI: 1.6,9.0), corona viruses; 3.1% (95% CI: 0.4,5.8), parainfluenza; 2.6% (95% CI: 0.4,4.8), adenovirus; 1.1% (95% CI: ,1.1 to 3.3), and human metapneumovirus; 0.7% (95% CI: ,0.3 to 1.8). Maximum WMP was observed in studies from Europe followed by the USA, Australia and Asia. Picorna was the most common virus detected in Western countries whereas influenza was most common in Asia. Conclusions: This systematic review demonstrated that viruses are strongly associated with AECOPD, with the highest detection rates of viruses being in Europe. The geographical epidemiology of viruses may have important therapeutic implications for management of AECOPD. [source] Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescentsBIPOLAR DISORDERS, Issue 6 2005Robert A Kowatch Objective:, Using predetermined criteria for study quality and methods, a literature review and meta-analysis of seven reports about pediatric bipolar disorder (BPD) was conducted to determine if there is a consistent picture of the phenomenology and clinical characteristics of BPD in children and adolescents. Methods:, Searches were conducted in MedLine and PsycINFO using the terms mania, BPD, children and adolescents, and was limited to published articles in peer-reviewed journals. Seven reports were selected that met the following criteria: a systematic method for the elicitation and reporting of symptoms and clinical characteristics of subjects; subjects were interviewed by a trained researcher or clinician; ages 5,18 years; use of a diagnostic system, either DSM or RDC for categorization; a consensus method for the establishment of the diagnosis of BPD. Results:, Most DSM-IV symptoms of mania were common in the children and adolescents with BPD with the most common symptoms being increased energy, distractibility, and pressured speech. On average, four of five bipolar cases also showed threshold levels of irritable mood and grandiosity, and more than 70% of all cases showed elated/euphoric mood, decreased need for sleep, or racing thoughts. Roughly 69% of cases also showed poor judgment, whereas only half of bipolar cases demonstrated flight of ideas, and slightly more than one-third showed hypersexuality or psychotic features. Conclusions:, The clinical picture that emerges is that of children or adolescents with periods of increased energy (mania or hypomania), accompanied by distractibility, pressured speech, irritability, grandiosity, racing thoughts, decreased need for sleep and euphoria/elation. [source] Antenatal Perineal Massage for Reducing Perineal TraumaBIRTH, Issue 2 2006M.M. Beckmann Background:, Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma. Objectives:, To assess the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity. Search strategy:, We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005), PubMed (1966 to January 2005), EMBASE (1980 to January 2005) and reference lists of relevant articles. Selection criteria:, Randomised and quasi-randomised controlled trials evaluating any described method of antenatal perineal massage undertaken for at least the last four weeks of pregnancy. Data collection and analysis:, Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. We contacted study authors for additional information. Main results:, Three trials (2434 women) comparing digital perineal massage with control were included. All were of good quality. Antenatal perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (three trials, 2417 women, relative risk (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat (NNT) 16 (10 to 39)). This reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.90 (95% CI 0.84 to 0.96), NNT 14 (9 to 35)). Women who practised perineal massage were less likely to have an episiotomy (three trials, 2417 women, RR 0.85 (95% CI 0.75 to 0.97), NNT 23 (13 to 111)). Again this reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.85 (95% CI 0.74 to 0.97), NNT 20 (11 to 110)). No differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd/4th degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.68 (95% CI 0.50 to 0.91) NNT 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage. Authors' conclusions:, Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage. *** The preceding report is an Abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464,780X). The Cochrane Database of Systematic Reviews 2006 Issue 1. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [source] Systematic Review of Emergency Physician,performed Ultrasonography for Lower-Extremity Deep Vein ThrombosisACADEMIC EMERGENCY MEDICINE, Issue 6 2008Patrick R. Burnside MD Abstract Objectives:, The authors performed a systematic review to evaluate published literature on diagnostic performance of emergency physician,performed ultrasonography (EPPU) for the diagnosis and exclusion of deep venous thrombosis (DVT). Methods:, Structured search criteria were used to query MEDLINE and EMBASE, followed by a hand search of published bibliographies. Relevance and inclusion criteria required prospective investigation of emergency department (ED) outpatients with suspected DVT; diagnostic evaluations had to consist of EPPU followed by criterion standard (radiology-performed) imaging. Two authors independently extracted data from included studies; study quality was assessed utilizing a validated tool for quality assessment of diagnostic accuracy studies (QUADAS). Pooled data were analyzed using an unweighted summary receiver-operating-characteristic (SROC) curve; sensitivity and specificity were estimated using a random effects model. Results:, The initial search yielded 1,162 publications. Relevance screening and selection yielded six articles including 936 patients. Four of the six studies reported adequate blinding but a number of other methodologic flaws were identified. A random effects model yielded an overall sensitivity of 0.95 (95% confidence interval [CI] = 0.87 to 0.99) and specificity of 0.96 (95% CI = 0.87 to 0.99). Conclusions:, Systematic review of six studies suggests that EPPU may be accurate for the diagnosis of DVT compared with radiology-performed ultrasound (US). However, given the methodologic limitations identified among the primary studies, the estimates of diagnostic test performance may be overly optimistic. Further research into EPPU for suspected DVT is needed before it can be adopted into routine clinical practice. [source] | ||||||||||||||||||||||||||||