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Biomedical subjects

P Knipschild

Publications and source records attributed to P Knipschild.

At least 19 recordsLinked to original sources
PubMed1998

Abdominal symptoms and food intolerance related to gallstones.

We have evaluated the association between gallstones and abdominal symptoms, comparing two different study designs. We asked questions on abdominal pain, dyspeptic symptoms, and food intolerance in (1) surgery patients referred for conditions unrelated to gallstones, screened by ultrasound (screening study, n = 892, 63 with gallstones); and in (2) symptomatic patients referred for gallbladder ultrasound (clinical study, n = 336, 71 with gallstones). Gallstones were associated with mid upper abdominal pain in the screening study, and with mid upper abdominal pain, biliary pain, and colic (each independently) in the clinical study. When these symptoms were absent (and only dyspeptic symptoms or food intolerance was present), gallstones were not more common than expected from the general population prevalence (estimated from the screening study). When upper abdominal pain symptoms are accounted for, other symptoms (dyspeptic; food intolerance; pain related to food intake) have no additional diagnostic value. The results are discussed, contrasting different types of studies.

Abdominal Pain↗
PubMed1996

A randomized clinical trial of ultrasound in the treatment of pressure ulcers.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the effects of ultrasound (US) therapy in the treatment of pressure ulcers as an adjunct to standardized treatment. SUBJECTS: Eighty-eight patients from 11 nursing homes and one hospital participated. Subjects were randomly assigned to either a US group (n = 45) or a sham US group (n = 43). METHODS: This was a multicenter placebo-controlled randomized trial. Wound survival, healing rates of wound surfaces, and changes on a clinical rating scale were measured over 12 weeks. RESULTS: Comparison of the 12-week cumulative incidences of wound closure showed that 40% (18/45) of ulcers in the US group and 44% (19/43) of ulcers in the sham US group were closed. An analysis in which between-group baseline differences and the days of wound closures were accounted for showed that the wound closure probability per unit of time (ie, closure rate) was almost equal in the two treatment groups (Cox proportional-hazards ratio of 1.08). Mean absolute healing rates were 0.18 and 0.31 cm2/wk in the US and sham US groups, respectively. Relative healing rates and healing speeds were similar in the two treatment groups. A panel scored slides of the ulcers with a report mark between 1 (bad) and 10 (excellent). The improvement was 0.71 and 0.46 points per week in the US and sham US groups, respectively. CONCLUSION AND DISCUSSION: These data do not support the idea that US speeds up the healing of pressure ulcers.

Aged↗
PubMed1995

Hyperbaric oxygen for multiple sclerosis. Review of controlled trials.

This review assesses the evidence of the efficacy of hyperbaric oxygen in multiple sclerosis. Material & methods - We used a list of predefined criteria for good methodology and interpreted the results of 14 identified controlled trials with emphasis on the quality. Results - At least eight trials can be considered to have a reasonable to high quality. In one of these 8 trials the results were in favour of hyperbaric oxygen treatment; the others found no clear positive effects. The patients had chronic progressive or chronic stable multiple sclerosis. In most trials, hyperbaric oxygen was supplied at pressures of 1.75-2 ATA, during 20 sessions of 90 min in 4 weeks. The principle endpoint was the (Expanded) Disability Status Score [(E)DSS] and the Functional Status Score as described by Kurtzke. Also specific outcomes such as evoked potentials were frequently used, but no consistent positive effects were demonstrated. Side effects were generally minor, ear and visual problems predominated. Conclusions - The majority of controlled trials could not show positive effects. Further evidence might consist of trials in patients with disease of recent onset or with other dosing regimens but the case for such further trials is not strong. Considering the state of affairs we cannot recommend the use of hyperbaric oxygen in the treatment of multiple sclerosis.

Activities of Daily Living↗
PubMed1995

Dyspepsia--how noisy are gallstones? A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance.

BACKGROUND: In contrast to earlier beliefs, it is nowadays assumed that no relation exists between dyspeptic symptoms and the presence of gallstones. Although many studies indeed failed to show a relation, each has been too small to exclude it. The aim of this meta-analysis is to systematically review epidemiologic studies and to synthesize the data. METHODS: Twenty-one controlled studies on the association between gallstones and dyspeptic symptoms were analyzed after critical appraisal with regard to selection bias, blinding, confounding, and data presentation. Most of them had reasonable validity. Inconsistencies between results of the studies could not be explained by differences in study design or validity. There was a slight indication of publication bias. RESULTS: Upper abdominal pain was consistently associated with gallstones (pooled odds ratios, about 2.0), with no preference for the right side. The findings on biliary pain were inconsistent. The results exclude with reasonable certainty an association between gallstones and 'classical' dyspeptic symptoms such as flatulence, heartburn, and acid regurgitation, bloating, and belching. An exception was nausea and vomiting (odds ratio, 1.4). Unspecified food intolerance was related to gallstones, but fat intolerance was not. CONCLUSIONS: We conclude that it is not sensible to call dyspeptic symptoms 'gallstone dyspepsia', since component symptoms do not show a consistent relation with gallstones, and their diagnostic meaning over and above abdominal pain has not been evaluated.

Abdominal Pain↗
PubMed1994

Systematic reviews. Some examples.

Reviewing the literature is a scientific inquiry that needs a clear design to preclude bias. It is a real enterprise if one aims at completeness of the literature on a certain subject. Going through refereed English language journals is not enough. On line databases are helpful, but mainly as a starting point. This article gives examples of systematic reviews on vitamin C and the common cold, pyridoxine against the premenstrual syndrome, homeopathy, and physiotherapy.

Ascorbic Acid↗
PubMed1993

Effects of preventive home visits to elderly people.

OBJECTIVES: To assess the effect of preventive home visits by public health nurses on the state of health of and use of services by elderly people living at home. DESIGN: Randomised controlled trial. SETTING: General population of elderly people in one of the southern regions of the Netherlands. SUBJECTS: 580 subjects aged between 75 and 84 years randomly allocated to intervention (292) or control (288) group. INTERVENTIONS: Four visits a year over three years in intervention group. Control group received no home visits. MAIN OUTCOME MEASURES: Self rated health, functional state, well being, loneliness, aspects of the mental state (depressive complaints, memory disturbances), and mortality. Use of services and costs. RESULTS: Visits had no effect on the health of the subjects. In the group visited no higher scores were seen on health related measures, fewer died (42 (14%) v 50 (17%)), and community care increased slightly. In the control group more were referred to outpatient clinics (166 (66%) v 132 (55%)), and they had a 40% increased risk of admission (incidence rate ratio 1.4; 90% confidence interval 1.2 to 1.6). No differences were found in long term institutional care, and overall expenditure per person in the intervention group exceeded that in the control group by 4%. Additional analyses showed that visits were effective for subjects who initially rated their health as poor. CONCLUSIONS: Preventive home visits are not beneficial for the general population of elderly people living at home but might be effective when restricted to subjects with poor health.

Aged↗
PubMed1993

Trials and errors.

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Clinical Trials as Topic↗
PubMed1993

Oral contraceptive use and the occurrence of gallstone disease--a case-control study.

BACKGROUND: We evaluated the hypothesized transient effect of oral contraceptive use on the occurrence of gallstone disease in a case-control study. METHODS: The study comprised 82 acute cases, and 249 general population controls, 28 elective cases, and 106 radiodiagnosis controls. Risk-period-specific rate ratios were estimated by logistic regression analysis. RESULTS: During the first 5 years after any year of oral contraceptive use (0- to 5-year risk period) the rate ratio was 1.6 (90% confidence interval, 0.83-2.95), and for the 6- to 10- and 11- to 20-year risk periods, 1.2 (0.67-2.13) and 1.1 (0.69-1.65), respectively. Further evaluation showed substantial confounding by other risk factors. After these were controlled for, the rate ratios were 1.1, 1.8, and 1.0 for the respective risk periods. When oral contraceptive use had been started recently (within 5 years before diagnosis) the rate ratio was 4.8 (0.79-29.7); recent oral contraceptive use was not associated with gallstone disease if preceded by 6 or more years of oral contraceptive use (rate ratio 0.8 (0.15-4.55)). CONCLUSIONS: The results are consistent with a transient effect of oral contraceptive use that does not accumulate beyond 10 years of use. However, the substantial confounding effect in our study raises the question whether the present and previously reported estimates of the effect may be biased by confounding.

Adult↗
PubMed1993

Oral contraceptives and the risk of gallbladder disease: a meta-analysis.

OBJECTIVES: This study was designed to assess the risk of gallbladder disease due to oral contraceptive use by conducting a thorough literature review. METHODS: Controlled epidemiologic studies published through March 1992 were systematically searched and evaluated. Of 25 studies (27 publications), 9 could stand the test of critical appraisal with respect to validity. Restriction to these studies was judged to circumvent publication bias at the same time. RESULTS: Oral contraceptive use is associated with a slightly and transiently increased rate of gallbladder disease. The results of six selected studies in which asymptomatic women were screened for gallstones were strikingly similar. Pooling of these results yielded an odds ratio, for ever vs never oral contraceptive use, of 1.36. A dose-effect relationship was indicated, suggesting that modern low-dose oral contraceptives are safer than older formulas, but an effect cannot be excluded. CONCLUSIONS: Considering the large efforts already devoted to this exposure-disease relationship, the probably weak effect, and the rapidly changing formulas of oral contraceptives, the authors suggest that the safety of new oral contraceptives be evaluated by studying bile saturation and biliary function rather than by waiting for gallbladder disease to develop.

Adolescent↗
PubMed1992

Ginkgo biloba.

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Animals↗
PubMed1992

The comprehensiveness of Medline and Embase computer searches. Searches for controlled trials of homoeopathy, ascorbic acid for common cold and ginkgo biloba for cerebral insufficiency and intermittent claudication.

OBJECTIVE: To assess the comprehensiveness of Medline and Embase computer searches for controlled trials. DESIGN: Comparison of articles found after an exhaustive search of the literature with the yield of a Medline or Embase search. This was performed for controlled clinical trials on the efficacy of three interventions: homoeopathy, ascorbic acid for common cold, and ginkgo biloba for intermittent claudication and cerebral insufficiency. The number of controlled trials found by exhaustive search of the literature was 107, 61 and 45, respectively. RESULTS: For homoeopathy, ascorbic acid and ginkgo the proportion of all trials found by Medline was 17%, 36% and 31% respectively and for Embase 13%, 25% and 58% respectively. After checking of the references in the Medline articles 44%, 79% and 76% of all trials were identified. After checking of the references in the Embase articles 42%, 72% and 93% of all trials were identified. About 20% of the articles was not correctly indexed. Of the best trials 68%, 91% and 83% could be found with Medline and 55%, 82% and 92% of the best trials were identified through Embase. CONCLUSIONS: For the topics mentioned, Medline and Embase searches are sufficient to get an impression of the evidence from controlled trials, but only if references in the articles are followed for further evidence. If one wants to get a more complete picture, additional search strategies make sense. Of course, this picture may be different for other topics.

Abstracting and Indexing↗
PubMed1992

Is gallstone disease caused by obesity or by dieting?

The effects of dieting and obesity on the risk of acute gallstone disease were evaluated in a case-control study in Maastricht, The Netherlands, during 1983-1986. The study comprised 151 cases with acutely symptomatic gallstone disease and 451 population controls. The effects of dieting and obesity as measured by body mass index (weight (kg)/height (m)2) were disentangled in a multivariate logistic regression analysis. Both dieting and body mass index were positively associated with the rate of gallstone disease. The association with dieting largely disappeared when initial body mass index was controlled for (rate ratio = 1.4, 95% confidence interval 0.8-2.4). Conversely, controlling for dieting did not affect the association between body mass index and gallstone disease. Analysis by risk period (year 1 and 2-5, 6-10, and 11-15 years prior to interview) did not show consistent risk period-specific effects when initial body mass index was controlled for. The authors conclude that dieting does not account for the association between obesity and gallstone disease. In obese persons, dieting does not increase the risk of acute gallstone disease over the long term.

Adult↗