Biomedical subjects

Alejandro R Jadad

Publications and source records attributed to Alejandro R Jadad.

28 records · Page 2Linked to original sources

PubMed2002

Awareness of sources of peer-reviewed research evidence on the internet.

CONTEXT: Peer-reviewed research evidence that was once available only to clinicians is now posted on the Internet and accessible to everyone, but levels of awareness of this evidence among patients and clinicians is not known. METHODS: Cross-sectional survey, conducted from July 1998 through January 2000, of cancer patients (n = 1998), their family physicians (n = 871), and all oncologists (n = 30) and oncology nurses (n = 44) at the Hamilton Regional Cancer Centre, Hamilton, Ontario. Comparisons made between and within groups to examine use of the Internet by patients and clinicians to find health information, and their awareness of organizations using Internet-based resources to promote evidence-based decision making. RESULTS: Response rates were 72%, 44%, 97%, and 84% for patients, family physicians, oncologists, and nurses, respectively; 47% of patients, 64% of family physicians, 100% of oncologists, and 72% of nurses reported that they used the Internet. Few patients were aware of the existence of the Cochrane Collaboration (1%), MEDLINE (13%), or the Program in Evidence-Based Care of Cancer Care Ontario (3%). Oncologists had the highest reported levels of awareness of the sources of evidence on the Internet. Most family physicians had not heard of any of the sources. CONCLUSIONS: The awareness of evidence sources on the Internet varies between patients and clinicians and across groups of clinicians, and some of the most rigorously developed sources of information are still unknown.

Adult↗

PubMed2002

Analysis of cases of harm associated with use of health information on the internet.

CONTEXT: There is concern about the potential harm associated with the use of poor quality health information on the Internet. To date, there have been no systematic attempts to examine reported cases of such harm. METHODS: We conducted a systematic review of the peer-reviewed literature, to evaluate the number and characteristics of reported cases of harm associated with the use of health information obtained on the Internet. Using a refined strategy, we searched MEDLINE (from 1966 to February 2001), CINAHL (from 1982 to March 2001), HealthStar (from 1975 to December 2000), PsycINFO (from 1967 to March 2001), and EMBASE (from 1980 to March 2001). This was complemented with searches of reference lists. Two authors separately reviewed the abstracts to identify articles that describe at least 1 case of harm associated with the use of health information found on the Internet. Articles of any format and in any language deemed possibly relevant by either researcher were obtained and reviewed by both researches. RESULTS: The search yielded 1512 abstracts. Of these 186 papers were reviewed in full text. Of these, 3 articles satisfied the selection criteria. One article described 2 cases in which improper Internet searches led to emotional harm. The second article described dogs being poisoned because of misinformation obtained on the Internet. The third article described hepatorenal failure in an oncology patient who obtained misinformation about the use of medication on the Internet. CONCLUSIONS: Despite the popularity of publications warning of the potential harm associated with using health information from the Internet, our search found few reported cases of harm. This may be due to an actual low risk for harm associated with the use of information available on the Internet, to underreporting of cases, or to bias.

Health Education↗

PubMed2002

Dorsal root entry zone lesioning used to treat central neuropathic pain in patients with traumatic spinal cord injury: a systematic review.

STUDY DESIGN: A systematic review was conducted for studies of any design. OBJECTIVES: To evaluate the effectiveness and safety of dorsal root entry zone lesioning in treating central neuropathic pain of patients with traumatic spinal cord injury. SUMMARY OF BACKGROUND DATA: Central neuropathic pain has a great impact on the quality of life of many patients with traumatic spinal cord injury. Dorsal root entry zone lesioning has become one of several treatment options. No previous systematic reviews were found that address this indication for the procedure. METHODS: Several computerized databases were searched along with reference lists of eligible articles and personal files of advisory panel members. Only primary studies of patients older than 13 years with both traumatic spinal cord injury and central neuropathic pain receiving dorsal root entry zone lesioning were included. Two assessors independently performed data extraction and quality assessment for all the studies. RESULTS: The selection criteria were met by 11 studies. All were case series of 5 to 54 patients. As reported by 10 of the studies, at least 50% of the patients attained more than 50% pain relief or experienced no pain limitation of activity and no need for narcotics. However, all the studies had poorly defined eligibility criteria or none at all, no control groups, and inadequate reporting of adverse effects. Only one study provided adequate patient description. None of the studies reported the validity, reliability, or responsiveness of outcome measures. CONCLUSIONS: Reviewed studies indicate promising results from dorsal root entry zone lesioning for the treatment of central neuropathic pain in selected patients with traumatic spinal cord injury. However, the strength of the evidence provided by the studies was poor in terms of study design, outcome measures, reports on the severity of adverse effects, patient selection criteria, and patient description. For these reasons, the evidence is weak for the use of dorsal root entry zone lesioning to relieve central neuropathic pain in patients with traumatic spinal cord injury.

Adult↗

PubMed2002

Examination of instruments used to rate quality of health information on the internet: chronicle of a voyage with an unclear destination.

OBJECTIVE: This study updates work published in 1998, which found that of 47 rating instruments appearing on websites offering health information, 14 described how they were developed, five provided instructions for use, and none reported the interobserver reliability and construct validity of the measurements. DESIGN: All rating instrument sites noted in the original study were visited to ascertain whether they were still operating. New rating instruments were identified by duplicating and enhancing the comprehensive search of the internet and the medical and information science literature used in the previous study. Eligible instruments were evaluated as in the original study. RESULTS: 98 instruments used to assess the quality of websites in the past five years were identified. Many of the rating instruments identified in the original study were no longer available. Of 51 newly identified rating instruments, only five provided some information by which they could be evaluated. As with the six sites identified in the original study that remained available, none of these five instruments seemed to have been validated. CONCLUSIONS: Many incompletely developed rating instruments continue to appear on websites providing health information, even when the organisations that gave rise to those instruments no longer exist. Many researchers, organisations, and website developers are exploring alternative ways of helping people to find and use high quality information available on the internet. Whether they are needed or sustainable and whether they make a difference remain to be shown.

Evaluation Studies as Topic↗

PubMed2002

Examining the evidence in anesthesia literature: a survey and evaluation of obstetrical postdural puncture headache reports.

PURPOSE: To describe a bibliographic database on the literature of postdural puncture headache (PDPH) in the obstetrical population, to describe the research architecture in this field, and to evaluate the quality of case-control studies, cohort studies, and controlled clinical trials on PDPH. METHODS: Computerized bibliographic searches, citation review, and hand searches were conducted to find all relevant citations on incidence, clinical course, prevention, or treatment of PDPH in parturients. The study design and topic(s) covered by each study were evaluated. Case-control studies and cohort studies were evaluated using the Quality Index; clinical trials were evaluated using the Jadad scale. RESULTS: One hundred ninety-six relevant citations were published between 1949 and 1999. Research on PDPH has been increasing rapidly with the majority of studies published in the 1990's. Incidence and prevention were the focus of over half of all citations. Optimal study designs were infrequently utilized. The methodological quality was poor for observational studies (Quality Index 10/29) and clinical trials (Jadad scale 2/5). CONCLUSION: Although the amount of research on PDPH in parturients is increasing, use of optimal study designs and improvement in methodology is needed.

Adult↗

PubMed2002

Attention-deficit hyperactivity disorder: critical appraisal of extended treatment studies.

We undertook a systematic review of the literature on the long-term treatment of attention-deficit hyperactivity disorder (ADHD). We used systematic strategies to identify randomized treatment studies in which treatment was administered for 12 weeks or more. We included 14 studies involving 1379 subjects. Because of the limited number of high-quality studies and the heterogeneity of outcome measures, we did not perform meta-analysis. We rated 5 studies as adequate for methodological quality. Five studies followed children for more than 26 weeks. Pharmacologic interventions were studied more frequently than non-pharmacologic ones. Six studies permitted evaluation of the effects of combined drug and behavioural intervention. Twenty-five different outcomes were measured using 26 different tests. Stimulant medication appears to reduce ADHD (7 studies), dysfunctional social behaviour (6 studies), and internalizing symptoms (2 studies). Available studies provide little evidence for improved academic performance with stimulants (3 studies). Medications other than stimulants have not been studied extensively (3 studies). Only 1 study showed that combination therapy adds to the effects of medication. Rigorous treatment research among representative samples of ADHD individuals is needed.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

Two wrongs don't make a right: harm aggravated by inaccurate information on the Internet.

There has been much concern expressed in the literature about the use of medical information on the Internet by patients and families. Although much work has been done to quantify the misinformation available on the Internet, there have not been reports of actual harm to children resulting from this misinformation. We present the case of a 1-year-old boy whose clinical course of diarrhea was complicated not only by inaccurate advice given by the emergency room physician, but also by the same advice received from the Internet.

Diarrhea↗

PubMed2000

Is acupuncture effective for the treatment of chronic pain? A systematic review.

Pain is the major complaint of the estimated one million U.S. consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, the effectiveness of acupuncture for chronic pain remains in question. Our aim was to assess the effectiveness of acupuncture as a treatment for chronic pain within the context of the methodological quality of the studies. MEDLINE (1966-99), two complementary medicine databases, 69 conference proceedings, and the bibliographies of other articles and reviews were searched. Trials were included if they were randomized, had populations with pain longer than three months, used needles rather than surface electrodes, and were in English. Data were extracted by two independent reviewers using a validated instrument. Inter-rater disagreements were resolved by discussion. Fifty one studies met inclusion criteria. Clinical heterogeneity precluded statistical pooling. Results were positive in 21 studies, negative in 3 and neutral in 27. Three fourths of the studies received a low-quality score and low-quality trials were significantly associated with positive results (P=0.05). High-quality studies clustered in designs using sham acupuncture as the control group, where the risk of false negative (type II) errors is high due to large sample size requirements. Six or more acupuncture treatments were significantly associated with positive outcomes (P=0.03) even after adjusting for study quality. We conclude there is limited evidence that acupuncture is more effective than no treatment for chronic pain; and inconclusive evidence that acupuncture is more effective than placebo, sham acupuncture or standard care. However, we have found an important relationship between the methodology of the studies and their results that should guide future research.

Acupuncture Therapy↗

PubMed1994

Dextromethorphan for the treatment of neuropathic pain: a double-blind randomised controlled crossover trial with integral n-of-1 design.

The aim was to compare the analgesic effectiveness and adverse effect incidence of oral dextromethorphan (DM) with placebo in patients with neuropathic pain. The first 10-day treatment period was a multiple-dose double-blind randomised controlled cross-over comparison of 13.5 mg of DM 3 times a day (t.d.s.) with placebo t.d.s.: 5 treatment pairs, each pair 1 day DM and 1 day placebo. The second 10-day treatment period used 27 mg of DM t.d.s. vs. placebo, with the same design. The study incorporated a 5 pair n-of-1 design for each of the 2 doses of DM. Patients took the study medication in addition to any pre-existing analgesic regime. Patients who reported benefit could continue with DM after the study. Nineteen patients with chronic neuropathic pain were studied over two 10-day treatment periods. Outcome measures were pain intensity, pain relief, adverse effects, mood, sleep and global rating of treatment. These were recorded by daily patient diaries and by clinic assessments before and after each treatment period. There were no significant differences between DM and placebo on any of the clinic assessment outcome measures. Two patients had significantly better analgesia on more than one outcome measure on within-patient testing. One had better analgesia with DM. The other had better analgesia with placebo. Ten patients had no adverse effects on either dose of DM. Two patients withdrew during the first treatment period because of adverse effects (which included increased pain intensity), and 5 during the second period. Five patients continued with DM after the study for 1-3 months. No long-term clinical benefit was apparent in those who continued with open DM. Dextromethorphan at either 40.5 or 81 mg daily did not relieve neuropathic pain.

Adult↗

PubMedDate not supplied

Addressing the emergence of pediatric vaccination concerns: recommendations from a Canadian policy analysis.

Ever since the advent of pediatric vaccination, individuals have expressed concerns about both its risks and benefits. These concerns have once again resurfaced among some segments of the population and could potentially undermine national vaccination programs. The views of the public, however, must be considered and respected in the formulation of vaccination policy. We have conducted an analysis of the pediatric vaccination "debate" in the Canadian context. We believe that there is common ground between those who support pediatric vaccination and those who are concerned about these programs. Based on our findings, we believe that the goal of public health authorities should be to maintain trust in vaccines by continuing to meet certain reciprocal responsibilities. To do so, we recommend the following: 1) increased investment in adverse event reporting systems; 2) request for proposals for consideration of a no-fault compensation program; 3) developing pre-emptive strategies to deal with potential vaccine risks; 4) further examination of mechanisms to improve communication between physicians and parents concerned about vaccination. All of these approaches would require additional investment in pediatric vaccination. However, such an investment is easy to justify given the benefits offered by pediatric vaccination and the ramifications of failing to maintain confidence in vaccination programs or missing a vaccine-related adverse event.

Adverse Drug Reaction Reporting Systems↗