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Selected AbstractsIs the placebo powerless?JOURNAL OF INTERNAL MEDICINE, Issue 2 2004Update of a systematic review with 52 new randomized trials comparing placebo with no treatment Abstract. Background., It is widely believed that placebo interventions induce powerful effects. We could not confirm this in a systematic review of 114 randomized trials that compared placebo-treated with untreated patients. Aim., To study whether a new sample of trials would reproduce our earlier findings, and to update the review. Methods., Systematic review of trials that were published since our last search (or not previously identified), and of all available trials. Results., Data was available in 42 out of 52 new trials (3212 patients). The results were similar to our previous findings. The updated review summarizes data from 156 trials (11 737 patients). We found no statistically significant pooled effect in 38 trials with binary outcomes, relative risk 0.95 (95% confidence interval 0.89,1.01). The effect on continuous outcomes decreased with increasing sample size, and there was considerable variation in effect also between large trials; the effect estimates should therefore be interpreted cautiously. If this bias is disregarded, the pooled standardized mean difference in 118 trials with continuous outcomes was ,0.24 (,0.31 to ,0.17). For trials with patient-reported outcomes the effect was ,0.30 (,0.38 to ,0.21), but only ,0.10 (,0.20 to 0.01) for trials with observer-reported outcomes. Of 10 clinical conditions investigated in three trials or more, placebo had a statistically significant pooled effect only on pain or phobia on continuous scales. Conclusion., We found no evidence of a generally large effect of placebo interventions. A possible small effect on patient-reported continuous outcomes, especially pain, could not be clearly distinguished from bias. [source] The Majority of Men with Lifelong Premature Ejaculation Prefer Daily Drug Treatment: An Observation Study in a Consecutive Group of Dutch MenTHE JOURNAL OF SEXUAL MEDICINE, Issue 4i 2007Marcel D. Waldinger MD ABSTRACT Introduction., Whether men with lifelong premature ejaculation (PE) prefer on-demand drug treatment to delay ejaculation time to daily drug treatment, has never been studied as a separate study question. Aim., To study how men with lifelong PE feel about the use of serotonergic antidepressants, and which option they would prefer for themselves: either a daily drug, a drug to be used on demand, or a topical anesthetic cream to be applied on demand. Main Outcome Measures., Treatment preference was determined by questionnaire. Methods., An observational questionnaire survey in a clinical sample. Preferences of different treatment strategies were queried before and after standard efficacy and safety information. Results., A consecutive group of 88 men with lifelong PE who decided for themselves to be seen for rapid ejaculation was studied. The age was 37 ± 11 years (mean ± SD), range 18,64 years. None of these men was ever treated for PE and 21% used medication that did not affect sexual performance. Of them, 71 (81%) preferred a drug for daily use, 14 (16%) a drug on demand, while three men preferred topical anesthetic cream. Those men who initially preferred daily treatment did not change their view after standard information about efficacy and side effects, while 9 of 17 men who initially preferred on-demand drug treatment had switched their preferences to daily oral drug usage. Around 60% of men did not care about the nature of the drug, i.e., an antidepressant. The most frequently reported argument to prefer daily drug treatment was that this strategy would have the least effects toward the spontaneity of having sex. Conclusion., As opposed to agents that must be taken 4,6 hours prior to coitus and with the methods used here, this group of Dutch men with lifelong PE favor uninterrupted daily drug treatment to delay ejaculation mainly because daily treatment guarantees no interference with the spontaneity of having sex. Waldinger MD, Zwinderman AH, Olivier B, and Schweitzer DH. The majority of men with lifelong premature ejaculation prefer daily drug treatment: An observation study in a consecutive group of Dutch men. J Sex Med 2007;4:1028,1037. [source] Situations of opportunity , Hammarby Sjöstad and Stockholm City's process of environmental managementCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 2 2008Örjan Svane Abstract Hammarby Sjöstad is a large brownfield development in Stockholm guided by extensive environmental objectives. This case study focuses on the environmental management of the city's project team. A main aim was methodology development related to the concept of situations of opportunity , how to study those periods when the team had great influence over the process. Goal conflicts on for example energy use and the lake view were identified. The team used policy instruments such as development contracts and design competitions. Some of the situations identified contributed little to the environmental management, for example the detailed planning. Others were more successful, for example the integration of infrastructural systems. Success situations were unique or created by the team, and had less formal power. Other situations had more power, but were burdened with a prehistory of routines and agreements. The methodology should also be applicable to other processes of environmental management. Copyright © 2007 John Wiley & Sons, Ltd and ERP Environment. [source] Interstitial cystitis, gynecologic pelvic pain, prostatitis, and their epidemiologyINTERNATIONAL JOURNAL OF UROLOGY, Issue 2003ANANIAS C. DIOKNO Abstract Aim: To determine a uniform definition of interstitial cystitis (IC) and to develop a strategy on how to study its epidemiology. Methods: Initially, the committee reviewed the literature regarding the definition of IC currently being used and information regarding its epidemiology. The committee held three 1-hour hearings and discussions on the opinions of invited IC specialists. The issues were presented and discussed. Consensus was sought when possible. The committee members met and summarized the gist of the three sessions. Results: A consensus emerged as to what constitutes IC. Interstitial cystitis must have the elements of chronic pelvic pain and urinary frequency and/or urgency. It was also the recommendation that the term IC be retained followed by chronic pelvic pain syndrome represented by the acronym IC/CPPS. A strategy on the epidemiologic study of IC/CPPS was also recommended. Conclusions: A consensus from this workshop has emerged in terms of defining the component of IC, the preferred terminology, and the strategy to study its epidemiology. [source] | ||||||||||