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Traditional Reviews (traditional + review)

Distribution by Scientific Domains

Medical Sciences	80%

Selected Abstracts

Role of meta-analysis of clinical trials for Alzheimer's disease

DRUG DEVELOPMENT RESEARCH, Issue 3 2002
Jesús M. López Arrieta
Abstract Alzheimer's disease (AD) is a growing worldwide medical, social, and economic problem. In all countries, both prevalence and incidence of this disorder increase with age. The task of translating scientific clinical research into effective interventions for dementia has proved to be a difficult challenge. Data about the effects of therapeutic interventions come from several sources of evidence, ranging from studies with little potential for systematic bias and minimal random error, such as well-designed randomized controlled trials, through controlled but nonrandomized cohort and case-control studies, all the way to opinions based on laboratory evidence or theory. Although clinical trials are widespread in AD, there is increasing recognition that the results of studies do not necessarily apply to the type of patients that are seen by clinicians because of differences in patient characteristics, comorbidities, cotherapies, severity of disease, compliance, local circumstances, and patients preferences, which may differ sufficiently from those in the trial situation to attenuate or change the benefit-to-risk ratio. There are several methods to address those issues, like pragmatic trials and n-of-1 trials. When data from randomized clinical trials do not provide clear answers from sufficiently similar studies in the magnitude of effect sizes, lack of statistical significance, or identification of subgroups, systematic reviews and meta-analysis may help to provide a better summary of the data. A major difference between a traditional review and a systematic is the systematic nature in which studies are chosen and appraised. Traditional reviews are written by experts in the field who use differing and often subjective criteria to decide what studies to include and what weight to give them, and hence the conclusions are often very diverse, depending on the reviewer. Publication and selection bias is a major concern of traditional reviews. Systematic reviews and meta-analysis are being increasingly used in dementia, propelled by the Cochrane Dementia and Cognitive Improvement Group, to make decisions about treatment, management, and care and to guide future research. This narrative review describes the rationale for randomized clinical trials and systematic reviews in dementia, particularly AD. Drug Dev. Res. 56:401,411, 2002. © 2002 Wiley-Liss, Inc. [source]

Incidence of heterotopic bone formation after major hip surgery

ANZ JOURNAL OF SURGERY, Issue 11 2002
Bruce Neal
Background: Heterotopic bone formation is a well-established complication of major hip surgery, but traditional reviews of the published literature may have underestimated its frequency. Methods: A systematic overview of all the relevant studies was performed to determine reliably the incidence of any heterotopic bone formation and the incidence of each Brooker equivalent grade. Separate estimates were made for patients with total hip replacement and patients with acetabular fracture repair. Results: A computer-based search identified 218 studies with data on the incidence of heterotopic bone formation after either hip replacement or acetabular fracture repair. These studies included data from an estimated 59 121 operated hips among patients that received total hip replacement and an estimated 998 hips among patients that underwent acetabular fracture repair. In these studies, the incidence of any heterotopic bone formation was 43% after total hip replacement and 51% after acetabular fracture repair. The incidence of severe heterotopic bone formation was 9% and 19%, respectively. Conclusions: These results suggest that heterotopic bone formation occurs more frequently after total hip replacement than is generally believed. It is possible that heterotopic bone formation is a more important cause of postoperative disability than has previously been recognized and that effective prophylactic regimens might improve outcome in substantial numbers of patients. [source]

The psychosocial well-being of children with chronic disease, their parents and siblings: an overview of the research evidence base

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2006
J. H. Barlow
Abstract Background Chronic disease of childhood may have implications for the psychosocial well-being of children and their families. The purpose of this paper is to provide an overview of the current literature regarding the psychosocial well-being of children with chronic disease, their parents and siblings. Methods Electronic searches were conducted using AMED, CINAHL, Cochrane Database, DARE, HTA, MEDLINE, NHS EED, PsycLIT, PsycINFO and PubMED (1990 to week 24, 2004). Inclusion criteria were systematic reviews, meta-analyses and overviews based on traditional reviews of published literature. The titles of papers were reviewed, abstracts were obtained and reviewed, and full copies of selected papers were obtained. Results Six reviews of the psychosocial well-being of children were identified: three on chronic disease in general, one on asthma, one on juvenile idiopathic arthritis and one on sickle cell disease. Two reviews of psychosocial well-being among parents and two reviews of sibling psychosocial well-being were identified. Evidence from meta-analyses shows that children were at slightly elevated risk of psychosocial distress, although only a minority experience clinical symptomatology. The proportion that experience distress remains to be clarified, as do contributory risk factors. Few conclusions can be drawn from the two reviews of parents. However, a meta-analysis of siblings showed that they are at risk from a number of negative effects. Conclusion This overview has highlighted the need to extend the evidence base for psychosocial well-being of children, parents and siblings. [source]