Biomedical subjects

D Pinder

Publications and source records attributed to D Pinder.

6 recordsLinked to original sources

PubMed2004

The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manoeuvre. OBJECTIVES: To assess the effectiveness of the Epley manoeuvre compared to other treatments available for posterior canal benign paroxysmal positional vertigo, or no treatment. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 1, 2004), MEDLINE (1966 to 2004), EMBASE (1974 to 2004) and reference lists of identified publications. Date of the most recent search was January 2004. SELECTION CRITERIA: Randomised trials of adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test). Comparisons sought: Epley manoeuvre versus placebo Epley manoeuvre versus untreated controls Epley manoeuvre versus other active treatment Outcome measures that were considered include: frequency and severity of attacks of vertigo; proportion of patients improved by each intervention; and conversion of a "positive" Dix-Hallpike test to a "negative" Dix-Hallpike test DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data and assessed trials for quality. MAIN RESULTS: Fifteen trials were identified but twelve studies were excluded because of a high risk of bias, leaving three trials in the review. Trials were mainly excluded because of inadequate concealment during randomisation, or failure to blind outcome assessors. The studies included in the review (Lynn 1995; Froehling 2000; Yimtae 2003) addressed the efficacy of the Epley manoeuvre against a sham manoeuvre or control group by comparing the proportion of subjects in each group who had complete resolution of their symptoms, and who converted from a positive to negative Dix-Hallpike test. Individual and pooled data showed a statistically significant effect in favour of the Epley manoeuvre over controls. There were no serious adverse effects of treatment. REVIEWERS' CONCLUSIONS: There is some evidence that the Epley manoeuvre is a safe effective treatment for posterior canal BPPV, although this is based on the results of only three small randomised controlled trials with relatively short follow up. There is no good evidence that the Epley manoeuvre provides a long term resolution of symptoms. There is no good evidence comparing the Epley manoeuvre with other physical, medical or surgical therapy for posterior canal BPPV.

Humans↗

PubMed2002

The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manoeuvre. OBJECTIVES: To assess the effectiveness of the Epley manoeuvre compared to other treatments available for posterior canal benign paroxysmal positional vertigo, or no treatment. SEARCH STRATEGY: The Cochrane Controlled Trials Register (Cochrane Library, Issue 2 2001), MEDLINE (1966 onwards), EMBASE (1974 onwards), and reference lists of identified publications. Date of the most recent search was June 2001. SELECTION CRITERIA: Randomised trials of adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test). Comparisons sought: - Epley manoeuvre versus placebo. - Epley manoeuvre versus untreated controls. Epley manoeuvre versus other active treatment. Outcome measures that were considered include: frequency and severity of attacks of vertigo; proportion of patients improved by each intervention; and conversion of a "positive" Dix-Hallpike test to a "negative" Dix-Hallpike test DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data and assessed trials for quality. MAIN RESULTS: Eleven trials were identified but nine studies were excluded because of a high risk of bias, leaving two trials in the review. Trials were mainly excluded because of inadequate concealment during randomisation, or failure to blind outcome assessors. Both studies included in the review (Lynn 1995, Froehling 2000) addressed the efficacy of the Epley manoeuvre against a sham manoeuvre by comparing the proportion of subjects in each group who had complete resolution of their symptoms, and who converted from a positive to negative Dix-Hallpike test. Individual and pooled data showed a statistically significant effect in favour of the Epley manoeuvre over controls. There were no serious adverse effects of treatment. REVIEWER'S CONCLUSIONS: ~bullet~There is some evidence that the Epley manoeuvre is a safe effective treatment for posterior canal BPPV, although this is based on the results of only two small randomised controlled trials with relatively short follow up. ~bullet~There is no good evidence that the Epley manoeuvre provides a long term resolution of symptoms. ~bullet~There is no good evidence comparing the Epley manoeuvre with other physical, medical or surgical therapy for posterior canal BPPV.

Humans↗

PubMed2002

The Epley manoeuvre for benign paroxysmal positional vertigo--a systematic review.

Benign paroxysmal positional vertigo (BPPV) is a syndrome characterized by short-lived episodes of vertigo in association with rapid changes in head position. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manouevre. Randomized clinical trials of the Epley manoeuvre were identified. Outcome measures that were considered include: frequency and severity of attacks of vertigo; proportion of patients improved by each intervention; and conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test. Patients who received the Epley manoeuvre were more likely to have complete resolution of their symptoms [odds ratio 4.92 (95% C.I. 1.84-13.16)], and more likely to convert from a positive to negative Dix-Hallpike test [odds ratio 5.67 (95% C.I. 2.21-14.56)]. There were no serious adverse effects of treatment. There is some evidence that the Epley manouevre is a safe effective treatment for posterior canal BPPV.

Humans↗

PubMed2001

Dissection versus diathermy for tonsillectomy.

BACKGROUND: Tonsillectomy is a commonly performed surgical procedure. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated. OBJECTIVES: To compare the morbidity associated with tonsillectomy by two different techniques - dissection and diathermy. SEARCH STRATEGY: Cochrane Controlled Trials Register, Medline (1966-2000), Embase (1974-2000). Reference lists were scanned for additional material. SELECTION CRITERIA: Randomised controlled trials of children and adults undergoing tonsillectomy or adenotonsillectomy by dissection or diathermy techniques. Trials were assessed for methodological quality according to the method outlined in the Cochrane Reviewers Handbook. DATA COLLECTION AND ANALYSIS: The reviewers assessed each trial and extracted data independently. MAIN RESULTS: Twenty-two potential studies were identified for further assessment. Twenty trials were not included because they did not meet the inclusion criteria for randomisation methods, controls or outcome criteria. Two trials met the inclusion criteria, one comparing monopolar dissection diathermy with conventional cold dissection in children, and the other comparing microscopic bipolar dissection with cold dissection in children and adults. These studies demonstrate reduced intraoperative bleeding, but increased pain in the diathermy group. There was no difference in the rate of secondary bleeding overall, although the power of both studies to detect a small difference was insufficient. REVIEWER'S CONCLUSIONS: There are insufficient data to show that one method of tonsillectomy is superior. There is evidence that pain may be greater after monopolar dissection. Large, well designed randomised controlled trials are necessary to determine the optimum method for tonsillectomy.

Adult↗

PubMed1992

Epidemiological study of ulcerative proctocolitis in Indian migrants and the indigenous population of Leicestershire.

A retrospective epidemiological study of ulcerative colitis (UC) and proctitis was performed in Leicestershire from 1972-89. Potential cases were identified from hospital departments of pathology, endoscopy, and medical records and from general practitioners. The county population includes more than 93,000 South Asians. There were 573 cases of UC and 286 of proctitis in Europeans and 115 cases of UC and 29 of proctitis in South Asians. The standardised incidence of UC in Europeans and South Asians was stable, except in Sikhs in whom it had increased rapidly. The relative risk of UC to South Asians was 2.45. The standardised incidences of UC in South Asians during the 1980s were: 10.8/10(5)/year in Hindus (95% confidence interval (CI) 7.4-14.1 cases/10(5)/year) 16.5/10(5)/year in Sikhs (95% CI 7.9-25.2 cases/10(5)/year), and 6.2/10(5)/year in Muslims (95% CI 1.6-10.9 cases/10(5)/year). There was no difference in incidence between Asians from East Africa and India. The standardised incidence of UC in Europeans was 5.3/10(5)/year (95% CI 4.3-6.3 cases/10(5)/year). The standardised incidences of proctitis were 3.1/10(5)/year (95% CI 1.9-2.5 cases/10(5)/year) in South Asians and 2.3/10(5)/year (95% CI 1.8-2.4 cases/10(5)/year) in Europeans. Ethnic groups had a similar disease distribution, except Sikhs in whom it was less extensive. Despite the similar disease distribution, South Asians had fewer operations and complications from UC than Europeans. There was a bimodal age specific incidence in Europeans, but not in other ethnic groups. First and second generation South Asians were at similar risk. Hindus and Sikhs have a significantly higher incidence of UC than Europeans in Leicestershire.

Adolescent↗

PubMed1992

Epidemiology of Crohn's disease in Indian migrants and the indigenous population in Leicestershire.

A retrospective, epidemiological community study of Crohn's disease was performed in Leicestershire from 1972 to 1989. The county population of 930,000 includes 93,000 South Asians. Potential cases were identified from hospital departments of pathology, endoscopy and medical records, in addition to general practitioners. There were 582 cases in Europeans and 28 in South Asians. The incidence of Crohn's disease in Europeans and South Asians has increased, particularly in Muslims. The standardized incidence in South Asians during the 1980s was 2.4/10(5)/year in Hindus, 3.4/10(5)/year in Sikhs and 5.4/10(5)/year in Muslims. The standardized incidence in Europeans has risen significantly to 4.7/10(5)/year from 3.4/10(5)/year in the 1970s (chi 2 = 8.1, p less than 0.005). In Leicester this increase can be accounted for entirely by new cases of colonic disease. All ethnic groups had a similar disease distribution. Small bowel disease was inversely associated with age, whilst colonic disease increased with age. However, the difference in age-specific incidence of Crohn's disease for different age bands at various sites was not significant. Overall, Hindus have a much lower incidence of Crohn's disease than Europeans.

Adolescent↗