Biomedical subjects

Arash Rashidian

Publications and source records attributed to Arash Rashidian.

6 recordsLinked to original sources

PubMed2006

The role of anticholinergics in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a systematic review and meta-analysis.

OBJECTIVE: To assess the safety and efficacy of anticholinergics in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) by a systematic review of published reports and a meta-analysis of the reported outcomes. METHODS: We searched Medline, Embase and Cochrane databases (1966-2006), and hand-searched relevant reference lists and conference proceedings, for studies on the use of anticholinergics in men with BPH or bladder outlet obstruction. Eligible studies were assessed for quality and foreign language studies were translated. We collected data on all reported outcomes, conducted meta- analyses on the maximum urinary flow rate (Q(max)), postvoid residual urine volume (PVR) and volume at first contraction, and calculated the acute urinary retention (AUR) rate. We used sensitivity analysis to confirm the findings. RESULTS: We identified five randomized controlled trials (RCTs) and 15 observational studies. Four RCTs incorporating 633 patients were included in the meta-analyses. Anticholinergics did not significantly alter Q(max) (0.1 mL/s, 95% confidence interval, CI, 0.6-0.7). The PVR was increased by 11.6 mL (95% CI 4.5-18.6) although there was no significant difference between AUR rates. The total International Prostate Symptom Scores (IPSS) were not significantly different, but there were improvements for IPSS storage subscores in one RCT. The AUR rate was 0.3% at the 12-week follow-up in 365 men in the RCTs and observational studies. CONCLUSION: Anticholinergic use in men with LUTS suggestive of BPH appears to be safe. Further studies are required to establish efficacy with a suitable precision.

Aged↗

PubMed2006

Investigating the effectiveness of critical care outreach services: a systematic review.

OBJECTIVE: We explored the impact of critical care outreach activity on patient and service outcomes and aimed to contribute to developing a typology of critical care outreach services. DESIGN: Following a sample search of Medline 15 relevant electronic databases were systematically searched from 1996 to 2004. Searches for publications from nine key authors and citations of eight key articles were performed. Hand searches of journals, bibliographies of reports and review articles, and conference abstracts were conducted. Relevant experts were contacted. A further two studies published after the review date were also included. Two reviewers assessed studies for inclusion, conducted quality assessment and extracted data. Data were synthesised using narrative techniques. MEASUREMENTS AND RESULTS: Seventeen papers and six brief reports were selected for inclusion from a list of 1,760 titles. As anticipated with a relatively new service such as critical care outreach, there were few controlled trials. There were two randomised controlled trials, 16 uncontrolled before and after studies, three quasi-experimental studies, one controlled before and after study and one post-only controlled study. The most frequent outcomes measured were mortality, cardiac arrest, unplanned critical care admissions from wards, length of stay, and critical care readmission rates. CONCLUSIONS: Although improvements in patient outcomes were found, the evidence in this review is insufficient to demonstrate this conclusively. The many differences in service delivery do not permit identification of service typology. Our findings point to a need for more comprehensive research of this expanding service in the United Kingdom.

Emergency Medical Services↗

PubMed2006

The thermo-expandable metallic stent for managing benign prostatic hyperplasia: a systematic review.

OBJECTIVES: To systematically review published reports of the safety, effectiveness and durability of a self-expanding metallic prostatic stent (Memokath, Engineers & Doctors A/S Ltd., Denmark) in patients with benign prostatic hyperplasia (BPH) who are unfit for surgery. METHODS: We systematically searched the Medline and Embase databases from 1992. The reference lists of included studies and the bibliographies of review articles were also searched. We contacted the manufacturer of Memokath for additional information. The primary outcomes were treatment failure (stent removal, replacement or repositioning) and urological symptom scores. Secondary outcomes were urodynamic indices and minor complications. Two reviewers independently assessed the methodological quality of the studies and extracted data. Data were synthesized using narrative techniques. RESULTS: In all, 14 case series described the use of the Memokath stent in 839 men with BPH. All patients were at high operative risk. Most studies were of poor quality with an inadequate follow-up. Treatment failure rates were 0-48% but the duration of follow-up was often unclear. Five studies reported International Prostate Symptom Scores and found reductions of 11-19 points after stent insertion. All seven studies that reported on maximum urinary flow rates found that these increased, and the four that described residual urine volumes found that these decreased. Minor complications were inconsistently reported. CONCLUSIONS: The Memokath stent can provide an effective treatment for BPH in men at high operative risk; it also appears to be safe, but inadequate follow-up does not allow firm conclusions on stent durability.

Aged↗

PubMed2006

Sample size for regression analyses of theory of planned behaviour studies: case of prescribing in general practice.

OBJECTIVES: Interest has been growing in the use of the theory of planned behaviour (TBP) in health services research. The sample sizes range from less than 50 to more than 750 in published TPB studies without sample size calculations. We estimate the sample size for a multi-stage random survey of prescribing intention and actual prescribing for asthma in British general practice. To our knowledge, this is the first systematic attempt to determine sample size for a TPB survey. METHODS: We use two different approaches: reported values of regression models' goodness-of-fit (the lambda method) and zero-order correlations (the variance inflation factor or VIF method). Intra-cluster correlation coefficient (ICC) is estimated and a socioeconomic variable is used for stratification. We perform sensitivity analysis to estimate the effects of our decisions on final sample size. RESULTS: The VIF method is more sensitive to the requirements of a TPB study. Given a correlation of .25 between intention and behaviour, and of .4 between intention and perceived behavioural control, the proposed sample size is 148. We estimate the ICC for asthma prescribing to be around 0.07. If 10 general practitioners were sampled per cluster, the sample size would be 242. CONCLUSIONS: It is feasible to perform sophisticated sample size calculations for a TPB study. The VIF is the appropriate method. Our approach can be used with adjustments in other settings and for other regression models.

Asthma↗

PubMed2004

Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital.

OBJECTIVE: The purpose of the study was to investigate the effects of introducing a critical care outreach service on in-hospital mortality and length of stay in a general acute hospital. DESIGN: A pragmatic ward-randomised trial design was used, with intervention introduced to all wards in sequence. No blinding was possible. SETTING: Sixteen adult wards in an 800-bed general hospital in the north of England. PATIENTS AND PARTICIPANTS: All admissions to the 16 surgical, medical and elderly care wards during 32-week study period were included (7450 patients in total, of whom 2903 were eligible for the primary comparison). INTERVENTIONS: Essential elements of the Critical Care Outreach service introduced during the study were a nurse-led team of nurses and doctors experienced in critical care, a 24-h service, emphasis on education, support and practical help for ward staff. MEASUREMENTS AND RESULTS: The main outcome measures were in-hospital mortality and length of stay. Outreach intervention reduced in-hospital mortality compared with control (two-level odds ratio: 0.52 (95% CI 0.32-0.85). A possible increased length of stay associated with outreach was not fully supported by confirmatory and sensitivity analyses. CONCLUSIONS: The study suggests outreach reduces mortality in general hospital wards. It may also increase length of stay, but our findings on this are equivocal.

Aged↗

PubMed2004

Practice nurses' intentions to use clinical guidelines.

BACKGROUND: Evidence indicates that, although nurses are increasingly using clinical guidelines to ensure higher quality of care, there is a wide variance in their adherence to them. The utility of the Theory of Planned Behaviour (TPB) has not been previously investigated in explaining this variance in community nursing. AIM: This paper reports a study whose primary aim was to examine the utility of the TPB in explaining variations in practice nurses' intentions to offer smoking cessation advice in accordance with coronary heart disease guidelines. METHODS: A cross-sectional survey using a postal questionnaire was carried out. A 52-item questionnaire was administered to 48 practice nurses in England. The questionnaire was designed to assess the components of the TPB, and included measures of intentions to offer smoking cessation advice, self-reported past behaviour, attitudes, subjective norms, perceived behavioural controls (PBCs), behavioural beliefs and evaluations, normative beliefs and motivation to comply, and control beliefs and evaluations. RESULTS: The TPB explained up to 40% of variance in intentions to offer smoking cessation advice. Attitudes and PBCs were the most important predictors of intention. Among other elements of the TPB, indirect attitudes and indirect PBCs made significant positive contributions to explaining variance in intention. DISCUSSION: Future trials of interventions to increase practice nurses' adherence to clinical guidelines could attempt to address the elements identified in this study as important factors. Further studies are required to examine the utility of the TPB in predicting practice nurses' behaviour.

Adult↗