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PubMed1997

A review of near patient testing in primary care.

AIMS AND OBJECTIVES: The aim was to identify publications relating to near patient testing (NPT), the use of alternative delivery systems between laboratory and general practice, including electronic data interchange (EDI), and computerised diagnostic decision support (CDDS), in the primary care setting to answer the following questions. What is the availability of NPT for primary care? What evidence is available to support the clinical effectiveness of NPT? What evidence is available on the accuracy and reliability of NPT within primary care? What evidence is available on the cost-effectiveness of different NPTs? How may CDDS improve the effectiveness of NPT? What evidence is available that compares NPT and existing laboratory services? What evidence is available on the cost-effectiveness of EDI or alternative delivery systems? HOW THE RESEARCH WAS CONDUCTED: Eight databases were searched, and the bibliographies from relevant publications checked for completeness. Unpublished work and publications not included in the databases were obtained by personal contact with collaborators, and from a postal survey sent to heads of academic departments of general practice and clinical chemistry and to researchers active or interested in the field worldwide. Questionnaires were also sent to 150 commercial organisations. Publications that met agreed definitions and reported original data were included in the systematic review. Of the 1057 publications identified, 102 (92 related to NPT, eight to CDDS, and two to EDI) were passed to the reviewers for appraisal of validity. The limited amount of published research relating to any particular NPT prohibited meta-analysis. Scoring systems to assess the validity of evaluations were also difficult to apply. RESEARCH FINDINGS: A wide variety of NPT systems have been developed. In general, the quality of the methods reported in the literature was poor. The issue of patient convenience and acceptability has not been adequately addressed. No evaluations of alternative delivery systems met the review criteria. No studies have evaluated the telephone or fax machine as a means of reporting results. For EDI, the majority of papers were descriptive. EDI and alternative delivery systems are not a replacement for NPT when the provision of an immediate result might have an impact on the quality of care. EDI may have clinical and cost advantages over traditional means of communication, but this has not been evaluated. The advisory role of the laboratory can be supported by CDDS. The use of CDDS and NPT has not, however, been fully evaluated. Few economic analyses have been conducted, and most were simple cost analyses. There are insufficient data for conclusions to be drawn on the cost-effectiveness of NPT in primary care. RECOMMENDATIONS: FURTHER SYSTEMATIC REVIEWS: Subject-specific systematic reviews are required that include laboratory and secondary care studies, and consider the potential for altering current management and patient acceptability. Priority topics include: biochemistry profiles on desktop analysers; cholesterol testing; urinalysis for the diagnosis of urinary tract infection; anticoagulation control; NPTs for the identification of acute infection. (ABSTRACT TRUNCATED)

Cost-Benefit Analysis↗

PubMed1997

A critical review of the relationship between gestational weight gain and preterm delivery.

OBJECTIVE: To review the relationship between gestational weight gain and preterm delivery. DATA SOURCES: We identified published studies through Medline searches (for the period 1980-1996), and we reviewed bibliographies from published articles. METHODS OF STUDY SELECTION: We excluded non-English-language articles and articles that used total weight gain, unadjusted for gestational age. Thirteen articles were identified for review. TABULATION, INTEGRATION AND RESULTS: Eleven of the 13 studies reported a significant association between maternal weight gain and risk of preterm delivery, and most reported that inadequate rate of maternal weight gain was associated with an increased risk (approximately 50-100%) of preterm delivery. Studies examining pattern of gain noted that a low rate of gain during the latter part of pregnancy (but not early pregnancy) was associated with an increased risk of preterm delivery (also approximately 50-100%). The studies' findings were relatively consistent, despite the use of diverse samples, study designs, and analytic strategies. CONCLUSION: The evidence suggests that a lower rate of weight gain during pregnancy is associated with an increased risk of preterm delivery, and that a slow rate of gain during the latter part of pregnancy may be particularly important. To improve our understanding of the mechanisms of these relationships, future studies should examine pattern of gain; they should stratify analyses on the different subtypes of preterm delivery and provide more detailed descriptions of methods for assessing gestational duration.

Delivery, Obstetric↗

PubMed1998

Quotation and reference accuracy of three nursing journals.

PURPOSE: To determine the accuracy of bibliographic citations in three widely circulated nursing journals, RN, Nursing Management, and Image: Journal of Nursing Scholarship. Accurate citations facilitate retrieval of the cited documents and establish the judgment and credibility of authors. DESIGN: Descriptive, comparative. METHODS: A random sample of 60 references per journal published July 1995 to June 1996 was reviewed for citation and quotation accuracy. Errors were classified as major or minor. Data were analyzed using the SAS statistical package. FINDINGS: Of the 180 references, 58 (32%) had citation errors, with 43 of 58 errors classified as major errors, which made retrieval of the cited work difficult; 12 of the 180 articles contained a major quotation error, including four instances where the content of the original article contradicted or was unrelated to the author's contention. CONCLUSIONS: The rate of citation and quotation errors in the three sampled nursing journals is comparable to rates previously reported for medical and nursing journals. Errors of citation and quotation diminish the value of published papers.

Bibliographies as Topic↗

PubMed1996

Promoting weight loss in type II diabetes.

OBJECTIVE: To examine strategies-behavioral therapies, exercise, diet, anorectic drugs, surgery, or a combination of strategies-used for promoting weight loss in people with type II diabetes. RESEARCH DESIGN AND METHODS: Meta-analysis was used to synthesize research of promoting weight loss in the population. Literature search strategies involved reviewing bibliographies, conducting computer searches and surveys of relevant master's degree programs, and contacting representatives of the Centers for Disease Control. The final sample consisted of 89 studies involving 1,800 subjects. Data were extracted on 80 variables characterizing the sample of studies/subjects and on 23 outcome variables, including weight, metabolic control, lipids, and other physiological parameters. RESULTS: Diet alone had the largest statistically significant impact on weight loss (-20 lb) and metabolic control (-2.7% in glycosylated hemoglobin). All diets significantly improved fasting blood sugar. Behavioral programs alone had a statistically significant impact on weight loss (-6.4 lb) and metabolic control (-1.5%) but effects were less than for diet alone. Data from the few exercise studies indicated that weighted average effects for exercise on weight loss (-3.4 lb) and metabolic control (-0.8%) were less than diet alone. Behavioral therapy plus diet plus exercise was associated with statistically significant effect size estimates for weight loss (-8.5 lb) and metabolic control (-1.6%). Diet alone achieved better results. Effects of weight promotion strategies, in general, were smaller in experimental studies and for individuals over age 55. CONCLUSIONS: Dietary strategies are most effective for promoting short-term weight loss in type II diabetes. A number of gaps exist in the extant literature- descriptions of subjects, interventions, or longitudinal outcomes beyond 12 months after intervention.

Blood Pressure↗

PubMedDate not supplied

[Ultra-rapid detoxification of opiate dependent patients: review of the literature, critiques and proposition for an experimental protocol].

UNLABELLED: Ultra-rapid opioid detoxification (UROD) is an increasingly popular technique for detoxifying patients addicted to opiates. This technique aims at reducing not only the duration but also the intensity of withdrawal by using general anesthesia coupled with a naloxone or naltrexone medication. In this paper the authors attempt to review the history of UROD and the logic of its procedure and results whilst also demonstrating its advantages and limits. METHOD: The MEDLINE database was searched from 1966 to 2000 using the terms "ultra-rapid opioid detoxification, rapid opioid detoxification under anesthesia, naloxone, naltrexone, opioid-related disorders". Additional data sources included bibliographies in textbooks on substance abuse. RESULTS: Nine studies identified in our search were analysed. The technique is based on a three-phases procedure. It consists of a medical and psychiatric selection of patients addicted to opiates, followed by the detoxification itself and finally a medical and psychosocial follow-up. A brief presentation is made of the theoretical aspects based on the use of a specific opioid receptor antagonist (naloxone and naltrexone). Only inpatients were included in the studies. The detoxification and anesthesia protocols varied. In every study all the subjects were completely detoxified. Only three studies included a control group and two used a randomized design. Three studies reported a follow-up beyond 30 days. DISCUSSION: Although this technique constitutes a safe and effective solution for opiate addicted patients, there are criticisms to be made. The absence of an animal model prior to the study of a human model, the lack of comparison with other procedures, the limitation of available literature, the cost and the risks of this technique and the lack of long-term treatment outcomes obtained from rigorous clinical trials, all call for further assessments. A more rigorous protocol based on the main areas of criticism is proposed (presentation of the inclusion and exclusion criterias, description of the three preliminary interviews, presentation of the UROD technique itself and finally a detailled nine month follow-up). CONCLUSION: Ultra-rapid opiate detoxification represents a potentially safe and effective treatment for opiate addicted patients but more rigorous research methods are needed to render this procedure entirely valid.

Anesthesia, General↗

PubMed2006

Quality of randomized controlled trials reporting in the primary treatment of brain tumors.

PURPOSE: To assess the reporting quality of randomized controlled trials (RCTs) in the primary treatment of brain tumors and to identify significant predictors of quality. PATIENTS AND METHODS: Two investigators searched MEDLINE, EMBASE, and bibliographies of retrieved articles for RCTs in the primary treatment of brain tumors published between January 1990 and December 2004. We assessed the quality of overall reporting and key methodologic factors reporting (allocation concealment, blinding, and intention to treat [ITT]). Two investigators also rated articles independently using items from the revised Consolidated Standards of Reporting Trials statement. A generalized estimated equation was used to generate regression models that identified significant factors associated with quality of reporting. RESULTS: We retrieved 74 relevant RCTs that randomly assigned 14,498 brain tumor patients. The quality of overall reporting has improved during the last 15 years, but eight of the 15 methodologic items were reported in less than 50% of trials. In the appraisal of the reporting quality of key methodologies, allocation concealment, blinding, and adherence to the ITT principle were reported in less than 30% of articles. Multivariable regression models revealed that an impact factor more than 1.66, publication after 1995, and sample size more than 280 were significant factors associated with better overall reporting, whereas complete industrial funding, impact factors more than 2.64, and positive primary outcomes were predictors of higher ratings of the three most important methodologic qualities. CONCLUSION: Despite improvement in general reporting quality, key methodologies that safeguard against biases may still benefit from better description. Significant factors associated with better reporting may act as surrogates for other characteristics.

Brain Neoplasms↗

PubMed1984

Target organs for carcinogenicity of chemicals and industrial exposures in humans: a review of results in the IARC monographs on the evaluation of the carcinogenic risk of chemicals to humans.

Epidemiological observations indicate that cancers affecting different organs and systems in humans have different causes. At the descriptive level, cancer incidence and mortality rates exhibit patterns of geographic and temporal variation which are distinct and separate for each cancer site and even, at a given site, for different histological types (for instance, increasing squamous cell carcinoma of the lung and decreasing stomach cancer in most developed countries in recent decades). The existence of these distinct patterns in itself indicates that different causes are at the origin of cancers at different sites. Hence, it is of scientific and practical importance not only to identify agents that are carcinogenic to humans but also to specify as definitely as possible the target organ(s) of their action. This is done in the present review of results in the International Agency for Research on Cancer Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans.

Bibliographies as Topic↗

PubMed2006

Setting and organization of care for persons living with HIV/AIDS.

BACKGROUND: Treating the world's 40.3 million persons currently infected with HIV/AIDS is an international responsibility that involves unprecedented organizational challenges. Key issues include whether care should be concentrated or decentralized, what type and mix of health workers are needed, and which interventions and mix of programs are best. High volume centres, case management and multi-disciplinary care have been shown to be effective for some chronic illnesses. Application of these findings to HIV/AIDS is less well understood. OBJECTIVES: Our objective was to evaluate the association between the setting and organization of care and outcomes for people living with HIV/AIDS. SEARCH STRATEGY: Computerized searches from January 1, 1980 to December 31, 2002 of MEDLINE, EMBASE, Dissertation Abstracts International (DAI), CINAHL, HealthStar, PsychInfo, PsychLit, Social Sciences Abstracts, and Sociological Abstracts as well as searches of meeting abstracts and relevant journals and bibliographies in articles that met inclusion criteria. Searches included articles published in English and other languages. SELECTION CRITERIA: Articles were considered for inclusion if they were observational or experimental studies with contemporaneous comparison groups of adults and/or children currently infected with HIV/AIDS that examined the impact of the setting and/or organization of care on outcomes of mortality, opportunistic infections, use of HAART and prophylaxis, quality of life, health care utilization, and costs for patient with HIV/AIDS. DATA COLLECTION AND ANALYSIS: Two authors independently screened abstracts to determine relevance. Full paper copies were reviewed against the inclusion criteria. The findings were extracted by both authors and compared. The 28 studies that met inclusion criteria were too disparate with respect to populations, interventions and outcomes to warrant meta-analysis. MAIN RESULTS: Twenty-eight studies were included involving 39,776 study subjects. The studies indicated that case management strategies and higher hospital and ward volume of HIV-positive patients were associated with decreased mortality. Case management was also associated with increased receipt of ARVs. The results for multidisciplinary teams or multi-faceted treatment varied. None of the studies examined quality of life or immunological or virological outcomes. Healthcare utilization outcomes were mixed. AUTHORS' CONCLUSIONS: Certain settings of care (i.e. high volume of HIV positive patients) and models of care (i.e. case management) may improve patient mortality and other outcomes. More detailed descriptions of care models, consistent definition of terms, and studies on innovative models suitable for developing countries are needed. There is not yet enough evidence to guide policy and clinical care in this area.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Breathing exercises for asthma.

BACKGROUND: There is much anecdotal evidence in Eastern and Western literature describing considerable benefits for patients with asthma when treated with breathing interventions. The term 'breathing exercise, training and retraining' has numerous interpretations depending on the nature of the therapy, therapist and cultural background. OBJECTIVES: To assess the evidence for the efficacy of breathing retraining in the treatment of patients with asthma. SEARCH STRATEGY: Trials were searched for in the Cochrane Airways Group trials register, Cochrane Complementary Medicine Field trials register, EMBASE: Physical Medicine & Rehabilitation Field, and Databases of the physiotherapy library of current research, World Congress of Physical Therapy Proceedings (1995) and AMED (Allied & Complementary Medicine Database 1985-2003/4). Hand searching of the Association of Chartered Physiotherapists in Respiratory Care Journals was undertaken. Chartered physiotherapists in the field of respiratory medicine were contacted and appeals made in the 'Physiotherapy' Journal and the Physiotherapy Respiratory Care magazine. Searches were undertaken of bibliographies from the included studies and other appropriate papers. Authors of included studies were contacted for information concerning other relevant trials. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials of breathing retraining in patients of all ages with a diagnosis of asthma. Breathing retraining should be a major component of the treatment intervention. DATA COLLECTION AND ANALYSIS: Two reviewers (EH & FR) independently assessed trial quality and extracted data. Authors of included trials were contacted for additional data. Where possible adverse effects were noted. MAIN RESULTS: Abstracts were identified and 42 full text papers were obtained for assessment and possible inclusion. Thirty five studies were excluded. A total of five studies were included in the original review. Two further studies have been added to this update. Most studies were of small size. Two studies demonstrated significant reductions in rescue bronchodilator use and three studies showed reductions in acute exacerbations, although these were measured in different ways. Two single studies showed significant improvements in quality of life measures. Overall, benefits of breathing exercises were found in isolated outcome measures in single studies. Five studies compared breathing retraining with no active control and two with asthma education control groups. REVIEWER'S CONCLUSIONS: Comparisons and conclusions were difficult to evaluate as treatment interventions and outcome measurements from the seven trials varied considerably. At present therefore no reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice. However trends for improvement, notably in quality of life measurements, are encouraging and further studies including full descriptions of treatment methods and outcome measurements are required.

Asthma↗

PubMed1992

A preliminary description of the United Kingdom community psychiatric nursing literature, 1960-1990.

Five hundred and two items about community psychiatric nursing have been located and classified. The data indicate a continuing rising trend in the number of publications on this subject. The majority of the literature is about the clinical role of the community psychiatric nurse (CPN) and is descriptive/analytical in nature. The second largest proportion is research, the third largest topic is management and administration and the fourth largest is CPN education. The amount of 'clinical' literature as a proportion of the whole has been in decline since the mid-1970s. The majority of papers cannot be classified by the specialism of community psychiatric nursing to which they relate, but a small and significant number have been written about the care of the elderly mentally ill. Overall, the practising CPNs have been the most prolific writers, followed by academic nurses and then nurse managers. Contributions from other professions are miniscule. Over recent years the contribution of nurse managers has declined, and that of academic nurses has risen. The contribution of practising CPNs remains robust. Research publications also continue to rise, the majority being produced by academics, but large contributions are also being made by nurse managers and practising CPNs. In the early years nearly all publications of articles were in populist nursing magazines. In recent years the spread of journals in which items about community psychiatric nursing appear has widened considerably.

Bibliographies as Topic↗

PubMed2004

Design and evaluation of a personal digital assistant- based alerting service for clinicians.

PURPOSE: This study describes the system architecture and user acceptance of a suite of programs that deliver information about newly updated library resources to clinicians' personal digital assistants (PDAs). DESCRIPTION: Participants received headlines delivered to their PDAs alerting them to new books, National Guideline Clearinghouse guidelines, Cochrane Reviews, and National Institutes of Health (NIH) Clinical Alerts, as well as updated content in UpToDate, Harrison's Online, Scientific American Medicine, and Clinical Evidence. Participants could request additional information for any of the headlines, and the information was delivered via e-mail during their next synchronization. Participants completed a survey at the conclusion of the study to gauge their opinions about the service. RESULTS/OUTCOME: Of the 816 headlines delivered to the 16 study participants' PDAs during the project, Scientific American Medicine generated the highest proportion of headline requests at 35%. Most users of the PDA Alerts software reported that they learned about new medical developments sooner than they otherwise would have, and half reported that they learned about developments that they would not have heard about at all. While some users liked the PDA platform for receiving headlines, it seemed that a Web database that allowed tailored searches and alerts could be configured to satisfy both PDA-oriented and e-mail-oriented users.

Attitude to Computers↗

PubMed1998

Meta-analysis of hyperhomocysteinemia as a risk factor for venous thromboembolic disease.

BACKGROUND: Elevated plasma homocysteine (Hcy) levels are implicated in the development of atherosclerotic and venous thromboembolic disease. A meta-analysis of the risk for venous thromboembolism (VTE) in the presence of hyperhomocysteinemia (hyper-Hcy) was performed. METHODS: Studies were identified through MEDLINE (January 1980 to August 1997) using search terms related to both Hcy and VTE. The bibliographies of all review articles and letters were searched for additional relevant articles. English-language studies were selected if they included 10 or more human subjects; a measurement of the plasma, serum, or whole-blood Hcy level; the presence of VTE; and primary data that were not published elsewhere. Seventy-two articles were retrieved, of which 9 met all inclusion criteria. Data were extracted on the study type, subject demographics, methods for matching control subjects with case patients, whether an objective method was used to diagnose VTE, and whether other causes of thrombophilia and elevated Hcy levels were considered. The mean Hcy levels, both in the fasting state and following methionine loading, if done, were recorded, as were the number of patients and control subjects with Hcy levels greater than 2 SDs or greater than the 95th percentile above the mean value of the control group. RESULTS: Nine case-control studies measured fasting plasma Hcy levels, and 5 also measured Hcy values after methionine loading. All 9 studies showed a similar qualitative trend in fasting levels in the associated risk for hyper-Hcy and VTE. The corresponding pooled odds ratio was 2.95 (95% confidence interval, 2.08-4.17; 2-sided P<.001), with no evidence for heterogeneity across the studies (P = .50). Following methionine loading, the trend was also toward increasing the risk of VTE with hyper-Hcy (odds ratio, 2.15; 95% confidence interval, 1.20-3.85; 2-sided P = .01). Again, no evidence of heterogeneity was found (P = .65). The pooled odds ratio for VTE in the presence of hyper-Hcy rose to 4.37 (95% confidence interval, 1.94-9.84) when studies with patients older than 60 years were excluded. Limitations of the individual studies included a lack of proper matching of patients with control subjects, a limited description of subject recruitment, and a failure to test for other hypercoagulable mechanisms and other causes of elevated Hcy levels, such as renal insufficiency or folate deficiency. CONCLUSIONS: A significant risk for VTE in the presence of hyper-Hcy apparently exists among a spectrum of patients with first or recurrent venous thromboembolic events. This risk appears to be most significant for patients with VTE disease before age 60 years. A well-designed prospective study is needed to confirm these findings.

Adolescent↗

PubMed1992

[The authors and the bibliographic references of the original articles published in the journal Atención Primaria (1984-1990)].

OBJECTIVE: The main aim of the study is to assess the developing situation of the articles published in the journal Atención Primaria in relation to the original articles included in the same journal. There are secondary aims of describing the amount of self-quotation, the profession of the authors, their geographical distribution and their use of bibliographic references. DESIGN: A descriptive analysis of the authors and bibliographic references in the original articles. SITE. Publications and research in Primary Care. MAIN MEASUREMENTS AND RESULTS: All the original articles published in the journal Atención Primaria during its first seven years (1984-1990). Gathering of data from the original articles (the number of authors, province of their place of work, titles, total number of references, references from Atención Primaria, the number of self-quotations, etc.) In the seven years studied, 295 original articles have been published by 1467 authors, 44% of whom are family doctors. The average number of authors per article was 5. There are twelve Spanish provinces from which no-one has published. Altogether 4,908 bibliographic references, an average of 16.6 per article, have been used. The number of references from the journal itself rose steadily from 1% in 1984 to 11.7% in 1988, but went down to 10.3% in 1990. 52% of the bibliographic references were in Castilian and 42.6% in English. CONCLUSION: The journal Atención Primaria is often quoted in original articles published in the same journal. The number of authors and references per original article is high but stable.

Authorship↗

PubMed2002

Exercise for treating fibromyalgia syndrome.

BACKGROUND: Fibromyalgia (FMS) is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. OBJECTIVES: The objective of this systematic review was to examine the efficacy of exercise training as an treatment for FMS. SEARCH STRATEGY: We searched 6 electronic bibliographies for studies of exercise training in FMS: MEDLINE (1966-12/2000), CINAHL (1982-12/2000), HealthSTAR (1990-12/2000), Sports Discus (1975-05/2000), EMBASE (1974-05/2000) and the Cochrane Controlled Trials Register (2000, issue 4). We also reviewed the reference lists from identified articles including reviews and meta-analyses of treatment studies. SELECTION CRITERIA: Randomized trials focused on cardiorespiratory endurance, muscle strength and/or flexibility as treatment for FMS were selected. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified trials meeting inclusion criteria, rated the methodologic quality using 2 standardized validated instruments, evaluated the adequacy of the exercise training stimulus using the American College of Sports Medicine (ACSM) criteria and evaluated the results. Disagreements were resolved through active discussion and consensus. High quality training studies had scores of 50% or greater on van Tulder methodologic criteria and met the minimum training standards of ACSM. Outcome variables were grouped into 7 constructs: pain, tender points, physical function, global well being, self efficacy, fatigue & sleep, and psychological function. Two reviewers independently extracted data on study characteristics, results and point estimates for selected variables, and used consensus to address discrepancies. MAIN RESULTS: Sixteen trials involving a total of 724 participants were assigned at random to: exercise intervention groups (n=379), control groups (n=277), or groups receiving an alternate treatment (n=68). Seven studies were high quality training studies: 4 aerobic training, 1 a mixture of aerobic, strength and flexibility training, 1 strength training and 2 with exercise training as part of a composite treatment. Flexibility protocols were never described in sufficient detail to allow evaluation. The four high quality aerobic training studies reported significantly greater improvements in the exercise groups versus control groups in aerobic performance (17.1% increase in aerobic performance with exercise versus 0.5% increase in the control groups), tender point pain pressure threshold (28.1% increase versus 7.0% decrease) and improvements in pain (11.4% decrease in pain versus 1.6% increase). Poor description of exercise protocols was common, with insufficient information on intensity, duration, frequency and mode of exercise. Adverse events were also poorly reported. REVIEWER'S CONCLUSIONS: Supervised aerobic exercise training has beneficial effects on physical capacity and FMS symptoms. Strength training may also have benefits on some FMS symptoms. Further studies on muscle strengthening and flexibility are needed. Research on the long-term benefit of exercise for FMS is needed.

Exercise↗

PubMed2000

Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration.

BACKGROUND: Chronic wounds, including pressure sores, leg ulcers, diabetic foot ulcers and other kinds of wounds, healing by secondary intention are common in both acute and community settings. The prevention and treatment of chronic wounds includes many strategies, including the use of various wound dressings, bandages, antimicrobial agents, footwear, physical therapies and educational strategies. This review is one of a series of reviews, and focuses on the prevention and treatment of diabetic foot ulcers and the role of antimicrobial agents in chronic wounds in general. OBJECTIVES: To assess the clinical- and cost-effectiveness of (1) prevention and treatment strategies for diabetic foot ulcers and (2) systemic and topical antimicrobial agents in the prevention and healing of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases were searched, including MEDLINE, CINAHL, Embase and the Cochrane Library. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. An expert panel was consulted. METHODS - STUDY SELECTION: Randomised and non-randomised trials with a concurrent control group, which evaluated any intervention for the prevention or treatment of diabetic foot ulcers, or systemic or topical antimicrobials for chronic wounds (diabetic foot ulcers, pressure ulcers, leg ulcers of various aetiologies, pilonidal sinuses, non-healing surgical wounds, and cavity wounds) and used objective measures of outcome such as: (1) development or resolution of callus; (2) incidence of ulceration (for diabetic foot ulcer prevention studies); (3) incidence of pressure sores (pressure sore prevention studies); (4) any objective measure of wound healing (frequency of complete healing, change in wound size, time to healing, rate of healing); (5) ulcer recurrence rates; (6) side-effects; (7) amputation rates (diabetic foot ulcer treatment studies); (8) healing rates and recurrence of disease, among others, for pilonidal sinuses. Studies reporting solely microbiological outcomes were excluded. Decisions on the inclusion of primary studies were made independently by two reviewers. Disagreements were resolved through discussion. Data were extracted by one reviewer into structured summary tables. Data extraction was checked independently by a second reviewer and discrepancies resolved by discussion. All included studies were assessed against a comprehensive checklist for methodological quality. INCLUDED STUDIES - DIABETIC FOOT ULCERS: Thirty-nine trials which evaluated various prevention and treatment modalities for diabetic foot ulcers: footwear (2), hosiery (1), education (5), screening and foot protection programme (1); podiatry (1) for the prevention of diabetic foot ulcers; and footwear (1), skin replacement (2), hyperbaric oxygen (2), ketanserin (3), prostaglandins (3), growth factors (5), dressings and topical applications (9), debridement (2) and antibiotics (2) for the treatment of diabetic foot ulcers. INCLUDED STUDIES - ANTIMICROBIALS: Thirty studies were included, 25 with a randomised design. There were nine evaluations of systemic antimicrobials and 21 of topical agents. QUALITY OF STUDIES: The methodological and reporting quality was generally poor. Commonly encountered problems of reporting included lack of clarity about randomisation and outcome measurement procedures, and lack of baseline descriptive data. Common methodological weaknesses included: lack of blinded outcome assessment and lack of adjustment for baseline differences in important variables such as wound size; large loss to follow-up; and no intention-to-treat analysis. RESULTS - PREVENTION OF DIABETIC FOOT ULCERS: There is some evidence (1 large trial) that a screening and foot protection programme reduces the rate of major amputations. The evidence for special footwear (2 small trials) and educational programmes (5 trials) is equivocal. A single trial of podiatric care reported a significantly greater reduction in callus in patients receiving podiatric care. RESULTS - TREATMENT OF DIABETIC FOOT ULCERS: Total contact casting healed significantly more ulcers than did standard treatment in one study. There is evidence from 5 trials of topical growth factors to suggest that these, particularly platelet-derived growth factor, may increase the healing rate of diabetic foot ulcers. Although these studies were of relatively good quality, the sample sizes were far too small to make any definitive conclusions, and growth factors should be compared with current standard treatments in large, multicentre studies. Topical ketanserin increased ulcer healing rate in 2 studies, while systemic hyperbaric oxygen therapy reduced the rate of major amputations in 1 study. Preliminary research into the effects of iloprost and prostaglandin E1 (PGE1) on diabetic foot ulcer healing suggests possible benefits. However, good quality, large-scale confirmatory research is needed. (ABSTRACT TRUNCATED)

Administration, Topical↗

PubMed1996

[Books published in Spain on smoking].

Tobacco dependence, considered for a long time as a habit and, more recently, as an addiction, has many bad effects in health. The objective of this study was to analyse books published in this field in Spain. Books indexed in the ISBN Spanish database in CD-ROM (updated to 1993) dealing with addiction to tobacco, that included one of the following words: tabac*, tabak*, tabaq*, fuma*, fumad*, nicotine*, alquitran*, antitabac*, antitabaq*, cigarro*, cigarri*, exfumad*, pipa*, puro*, picadura* or filtro, were included in the study. Authors, ISBN classification, year of publication, language (of publication and original) and publishers were descriptively analysed. One hundred and four books were analysed. The highest number was published during the period 1990-1993 (42%); being 1993 (n = 15) and 1991 (n = 14) the most productive years. A big increase was observed from 1985. A great number (76% of books, n = 79) was written by personal authors and the 14% (n = 14) by public organizations. Most of the books (n = 88; 85%); were published in Spanish, followed by Catalan (n = 13; 13%); 21 books (20%) were translations: most of them from English (n = 12; 60%) or from French (n = 3; 14%). Forty six per cent of books was published by trade publishers and 31% by public organizations. According to the ISBN classification, these books were grouped in 20 different topics; but, most of them (70%) were included in three of these topics: hygiene (n = 42, 40%), pharmacology-toxicology-drugs (n = 18, 17%) and pathology-diseases and medical/therapeutical clinical practice (n = 14; 13%). The number of books published in Spain dealing with tobacco dependence has increased very much from 1985; it suggests that interest in this area in SPain has also increased. Most of the books are published in Spanish, and the most frequently translated language is English. These books are basically published by trade publishers and public organizations. These results have to be considered taking into account that fighting against consumption of tobacco and tobacco dependence is a relatively new area of research and study.

Bibliographies as Topic↗

PubMed1986

The history of oesophageal atresia and tracheo-oesophageal fistula--1670-1984.

The history of oesophageal atresia commenced in the year 1670 with Durston's description of "A narrative of a monstrous birth at Plymouth". However, the most significant contribution in the 17th century was made by Gibson, who clearly described the clinical picture and necropsy findings in a baby with a proximal oesophageal atresia and a distal tracheo-oesophageal fistula. The 18th century was singularly lacking in contributions to the literature, but there were many important presentations during the 19th century. Early in that century Martin in France and Hill in United States of America contributed to the literature; subsequently, many anecdotal references can be found particularly in England, and ultimately a surgical attempt to correct the anomaly was made in 1888 by Steele in London. With this, the pre-surgical era gave way to the surgical era, and at a later stage pre-survival era was to give way to the survival phase. Reference will be made in the text to these various phases in the history and to the many pioneering surgical endeavours which took place in the earlier years of the 20th century. It will be seen that the surgical efforts employed palliative procedures, indirect attacks on the problem and finally direct attacks. The classic successes by indirect methods which were achieved by Ladd and Leven in babies born in 1939 were to be followed by the first successful end-to-end anastomosis which was achieved in Ann Arbor, Michigan, by Cameron Haight. Others had attempted primary anastomosis, and Lanman in particular deserves mention. However, it was Cameron Haight who opened a new era in the history of the treatment of oesophageal atresia; the recent history is largely concerned with increasing experience and refinements in technique. For the future historian many pathways can still be explored, including oesophageal replacement, the unstable trachea, follow-up studies and research projects. This history also included comments on the history of the less frequently encountered anomalies and such aspects as classification and radiology. The history of oesophageal atresia and tracheo-oesophageal fistula is a mini history of surgery - "oesophageal atresia is the epitome of modern surgery".

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