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PubMed2004

[Preventive home visits to the elderly: systematic review of available evidence].

The aim of preventive home visits to elderly persons is to reduce mortality, to avoid admissions to nursing homes and hospitals and to improve the functional status and general wellbeing of the elderly. Preventive home visits are rarely a standard service in national health care systems. For over 20 years, controlled randomized studies have been carried out to test their effectiveness. This systematic review evaluates the evidence available on preventive home visits for elderly persons in the context of considerations relating to the incorporation of such a service into the German health care system. Three current systematic reviews (two of them meta-analyses) were identified in a systematic literature survey. They consider a total of 26 studies, most of them RCTs. A further three original controlled studies were identified and evaluated. The original studies were very heterogeneous with respect to goals, target groups, intensity and duration of the home visit programme and with respect to the individuals performing the study (number, profession, qualifications and cooperation). This makes it more difficult to perform a pooled overall evaluation. It was possible to consider mortality, admissions to nursing homes, functional status and psychosocial status as relevant target parameters. The systematic reviews arrive at different assessments of effectiveness. A quantitative, across-studies evaluation demonstrated that preventive home visits to elderly persons were effective both in studies with selected and with unselected inclusion of participants. The second meta-analysis did not confirm this result. Effectiveness here was only demonstrated using stratified analyses which investigated a large number of home visits, the performance of a multidimensional assessment with follow-up visits and the average age and morbidity of participants as relevant influencing factors. However no factor exerted an influence over more than one of the investigated target parameters. The findings thus constitute very unspecific evidence of effectiveness with largely unclear determinants of success. Preventive home visit programmes have been tested in various health systems. Results from controlled (randomised) German studies have not been published to date. The results of studies from other countries have only limited applicability to the conditions in the German health care system because the opportunities for, and extent of, economical and effective improvement in the preventive care of the elderly depend on the standard of care existing in the individual country. The additional value of screening depends on the empirical level of care and not on a given standard. At present the introduction of home visits in Germany cannot be recommended beyond studies. However there appear to be sufficient reasons for controlled studies in Germany which should be carried out in a coordinated way with mutual agreement on concepts.

Aged↗

PubMedDate not supplied

A systematic review of the evidence supporting the use of priority dispatch of emergency ambulances.

OBJECTIVES: Systematic reviews of the literature assist in the location, appraisal, and synthesis of available evidence. This systematic review aimed to 1) assess the existing literature evaluating the effect of the priority dispatch of emergency ambulances on clinical outcome and ambulance utilization and 2) assess the relative effectiveness of sources of literature relevant to prehospital care. METHODS: Systematic review. The quality of each paper was assessed using a standardized seven-point scoring schedule. Sources used were: Medline, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), Bath Information & Data Services (BIDS), bibliographic searching, contacting researchers active in the field, and hand-searching relevant journals. Key words used were: "ambulance," "prioritisation," "dispatch," and "triage." RESULTS: Three hundred twenty-six papers were identified: 64 (19.6%) were related to the prioritization of emergency ambulances, and only 20 (6.1%) contained original data. The overall quality of publications was poor, seven (35%) papers having a quality score > or = 4. Only half were identified by electronic databases, 55% were identified by people working in the field, and two (10%) were identified by hand-searching (some papers were identified by more than one source). Two high-quality papers support the concept that criteria-based dispatch (CBD) improves clinical outcome; two other papers support CBD's role in improving ambulance utilization. CONCLUSIONS: There is very little evidence to support the effect of the prioritization of emergency ambulances on patient outcome. Electronic databases identify only approximately half of all relevant prehospital literature. Future systematic reviews in this area should use electronic databases, supplemented by contact with appropriate experts.

Ambulances↗

PubMed2005

Can Cochrane Reviews in controversial areas be biased? A sensitivity analysis based on the protocol of a Systematic Cochrane Review on low-level laser therapy in osteoarthritis.

OBJECTIVE: The aim of this study was to test if a conclusion in a systematic review of low-level laser therapy (LLLT) for osteoarthritis from the Cochrane Library was valid and robust. BACKGROUND DATA: Health policy decisions often rely on conclusions from the Cochrane Database of Systematic Reviews for approval of new therapies, although their validity for controversial non-pharmacological treatment has been questioned. METHODS: Validity was tested against a nine-item checklist for systematic reviews. Review selections were analyzed for possible discrepancies between trial and review reports, and omissions of relevant trials and data. Alternative data from discrepancies and omissions were then imputed in a sensitivity analysis, to test if review conclusions were robust. RESULTS: Only clinicians who had performed LLLT trials with negative results were invited into the review group. Review quality was sound in areas of literature search and methodological assessments, and some of the limitations were mentioned. The statistical analysis held 18 questionable selections such as omissions of trials, data, and subgroup analyses. These selections systematically favored the negative review conclusion. Without altering the review protocol, the sensitivity analysis of combined results changed to significantly positive for continuous and categorical data when data from all included trials were combined. Further sensitivity analyses with inclusion of valid non-included trials, performance of missing follow-up, and subgroup analyses revealed consistent and highly significant results in favor of active LLLT. CONCLUSIONS: In this example, the Cochrane review conclusion was neither robust nor valid. Representation of experts and different views on efficacy in the review group and extensive use of sensitivity analyses could probably improve quality control of reviews in areas of controversy.

Bias↗

PubMed2004

Dietary supplements for body-weight reduction: a systematic review.

BACKGROUND: Compliance with conventional weight-management programs is notoriously poor, and a plethora of over-the-counter slimming aids are sold with claims of effectiveness. OBJECTIVE: The objective of the study was to assess the evidence from rigorous clinical trials, systematic reviews, and meta-analyses on the effectiveness of dietary supplements in reducing body weight. DESIGN: The study was a systematic review. Literature searches were conducted on Medline, Embase, Amed, Cinahl, and the Cochrane Library until March 2003. Hand searches of medical journals, the authors' own files, and bibliographies of identified articles were conducted. There were no restrictions regarding the language of publication. The screening of studies, selection, validation, data extraction, and the assessment of methodologic quality were performed independently by the 2 reviewers. To be included, trials were required to be randomized and double-blind. Systematic reviews and meta-analyses of dietary supplements were included if they were based on the results of randomized, double-blind trials. RESULTS: Five systematic reviews and meta-analyses and 25 additional trials were included and reviewed. Data on the following dietary supplements were identified: chitosan, chromium picolinate, Ephedra sinica, Garcinia cambogia, glucomannan, guar gum, hydroxy-methylbutyrate, plantago psyllium, pyruvate, yerba maté, and yohimbe. The reviewed studies provide some encouraging data but no evidence beyond a reasonable doubt that any specific dietary supplement is effective for reducing body weight. The only exceptions are E. sinica- and ephedrine-containing supplements, which have been associated with an increased risk of adverse events. CONCLUSIONS: The evidence for most dietary supplements as aids in reducing body weight is not convincing. None of the reviewed dietary supplements can be recommended for over-the-counter use.

Complementary Therapies↗

PubMed2002

A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery.

UNLABELLED: This quantitative systematic review compared the efficacy and safety of ephedrine with phenylephrine for the prevention and treatment of hypotension during spinal anesthesia for cesarean delivery. Seven randomized controlled trials (n = 292) were identified after a systematic search of electronic databases (MEDLINE, EMBASE, The Cochrane Controlled Trials Registry), published articles, and contact with authors. Outcomes assessed were maternal hypotension, hypertension and bradycardia, and neonatal umbilical cord blood pH values and Apgar scores. For the management (prevention and treatment) of maternal hypotension, there was no difference between phenylephrine and ephedrine (relative risk [RR] of 1.00; 95% confidence interval [CI], 0.96-1.06). Maternal bradycardia was more likely to occur with phenylephrine than with ephedrine (RR of 4.79; 95% CI, 1.47-15.60). Women given phenylephrine had neonates with higher umbilical arterial pH values than those given ephedrine (weighted mean difference of 0.03; 95% CI, 0.02-0.04). There was no difference between the two vasopressors in the incidence of true fetal acidosis (umbilical arterial pH value of <7.2; RR of 0.78; 95% CI, 0.16-3.92) or Apgar score of <7 at 1 and 5 min. This systematic review does not support the traditional idea that ephedrine is the preferred choice for the management of maternal hypotension during spinal anesthesia for elective cesarean delivery in healthy, nonlaboring women. IMPLICATIONS: Phenylephrine and ephedrine to manage hypotension during spinal anesthesia for elective cesarean delivery were compared in this systematic review. Women given ephedrine had neonates with lower umbilical cord blood pH values compared with those given phenylephrine. However, no differences in the incidence of fetal acidosis (pH value of <7.2) or neonatal Apgar scores were found.

Anesthesia, Obstetrical↗

PubMed2002

Implementing a systematic course/clerkship peer review process.

OBJECTIVE: A systematic course/clerkship peer-review process was developed to meet several objectives: improvement of quality of course/clerkship, enhancement of understanding of individual course and overall curricular content, improvement of communication and collaboration between basic science and clinical disciplines across campuses, provision of forum to address curricular concerns of students and faculty, facilitation of data collection for LCME reviews and the AAMC CurrMIT project; and monitoring curricular equivalency at multiple clinical sites. DESCRIPTION: Previously each course had carried out an internal review process. These reviews varied considerably in terms of the data collected and how those data were used for quality improvement. Data and outcomes of the internal reviews were seldom shared with colleagues, students, or administrators. This limited communication discouraged collaboration and led to disparity in curricular content between campuses. A collaborative effort between the medical school's Office of Medical Education (OME) and the Education Council, the faculty governance committee composed of faculty from each basic science and clinical department on each campus, has led to the development and implementation of a systematic course/clerkship peer-review process. Two standing committees of the Education Council oversee the systematic review process. One committee is charged with oversight of the first two years of the curriculum and a second committee with oversight of the third and fourth years. A two-tiered course/clerkship review process was designed with all courses undergoing a limited annual review. A comprehensive, "nuts and bolts" review for required courses was to occur every three years. The limited annual review was based on course evaluations completed by students, collected and summarized by the OME, and presented to the Education Council. The comprehensive review of a required course/clerkship occurred over a six-to-eight-month period. Course directors on each campus completed a questionnaire and submitted materials. To facilitate cross-discipline communication and synergy, a subcommittee composed of both basic science and clinical faculty, principally course directors, and at least one medical student who had completed the course at each campus reviewed submitted materials and had a series of meetings with the course directors, support personnel, and department chairs. Final review reports presented to the Education Council identify issues, concerns, and recommendations for action. To date 11 required courses have completed the comprehensive review process. Simple oversights, significant curricular disparity between campuses, and opportunities for multidisciplinary collaboration have been identified and addressed. Student-rated satisfaction has improved for those courses that have been reviewed. DISCUSSION: The systematic course/clerkship peer-review process has been a success, although there was initial resistance to "outside review." We have not yet completed one cycle of comprehensive course reviews but already faculty and administration have a better understanding of individual course and overall curriculum content. Faculty have developed working relationships and are sharing educational strategies across disciplines and campuses, and identifying innovative collaborations. The annual review process is now perceived to lack depth and is under reconsideration.

Clinical Clerkship↗

PubMedDate not supplied

The efficacy of pentoxifylline in the treatment of vascular dementia: a systematic review.

This systematic review seeks to (1) summarize the pharmacologic effects of pentoxifylline on the cerebrovasculature and (2) review critically the studies evaluating pentoxifylline in the treatment of vascular dementia. To retrieve all relevant published and unpublished studies, we performed with no language restrictions computer keyword searches of MEDLINE, EMBASE, and Cochrane Library databases; reviewed bibliographies; and contacted the pharmaceutical manufacturer. We included pertinent articles if they met three quality criteria: randomized, double-blinded, and placebo-controlled study design; objective diagnostic criteria for vascular dementia; and reported original data. The literature search identified a total of 20 articles; however, only four studies met the quality criteria for inclusion in this systematic review. All four studies suggested a trend toward improved cognitive function in patients treated with pentoxifylline. Three of the studies performed a subgroup analysis using a stricter definition for vascular dementia. In these secondary analyses, the studies noted statistically significant differences in cognitive function between placebo and treatment groups. In conclusion, this systematic review suggested a potential therapeutic role for pentoxifylline in vascular dementia. However, few studies met the quality criteria for inclusion in this systematic review, and most of these studies were small and had methodologic limitations.

Cognition↗

PubMed2001

Chemical sympathectomy for neuropathic pain: does it work? Case report and systematic literature review.

OBJECTIVE: To determine if chemical sympathectomy successfully reduces limb neuropathic pain. DESIGN: Systematic literature review of the effectiveness of phenol or alcohol sympathectomy for extremity neuropathic pain. PATIENT: A 29-year-old female with complex regional pain syndrome of both lower extremities after back surgery who was submitted to bilateral lumbar chemical sympathectomy. SEARCH STRATEGY: The Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, Medline, and EMBASE were systematically searched. OUTCOME MEASURES: (1) For the patient in question: spontaneous pain, allodynia, pinprick hyperalgesia, pressure evoked pain; (2) For the literature review: meaningful versus nonmeaningful pain relief based on degree and duration (>2 weeks) of pain relief. RESULTS: (1) The case reported experienced partial temporary relief of pain primarily related to selective modulation of allodynia, but not deep pain or pinprick hyperalgesia; (2) 44% of 66 patients in 13 studies that met the authors' inclusion criteria experienced meaningful pain relief. Whereas 19% experienced no meaningful relief, for the remaining 37% of the patients no conclusions regarding duration and degree of relief could be drawn due to poor reporting of outcomes. CONCLUSIONS: Based on the case reported and systematic literature review, chemical sympathectomy seems to have at best a temporary effect, limited to cutaneous allodynia. Despite the popularity of chemical sympatholysis, only few patients and poorly defined outcomes are reported in the literature, substantiating the need for well-designed studies on the effectiveness of the procedure.

Adult↗

PubMedDate not supplied

Brief reports for disseminating systematic reviews to nurses.

Much has been written about the importance of using research findings to guide nursing practice. How to best disseminate those findings to nurses remains a challenge. In many clinical settings, nurses interested in research utilization and evidence-based practice retrieve, review, and integrate knowledge from research reports to guide decisions about best practices. Major barriers to this approach, however, are staff nurses' lack of time, expertise, and resources for this process. One approach to overcoming these barriers is to disseminate the results of systematic research reviews directly to nurses in the form of brief reports, written in an easy-to-understand style, and sent via e-mail. This article describes the development of brief reports as a strategy for disseminating the results of systematic reviews to staff nurses. To demonstrate the use of brief reports for this purpose, we chose a systematic review published in the Cochrane Database of Systematic Reviews.

Attitude of Health Personnel↗

PubMed2001

A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature.

STUDY DESIGN: Systematic review of prognostic studies of acute whiplash. OBJECTIVES: To update the systematic review on the prognosis of acute whiplash published by the Quebec Task Force on Whiplash-Associated Disorders and to propose a new conceptual framework to conduct systematic reviews on prognosis. SUMMARY OF BACKGROUND DATA: In 1995, the Quebec Task Force published a systematic review of the literature on whiplash and concluded that its prognosis is favorable. However, few prognostic factors were identified. Recent studies have added to this knowledge, and there is a need to update the review conducted by the Quebec Task Force. METHODS: A bibliographic search of four electronic databases was performed to identify prognostic studies of acute whiplash published after 1995. The literature was appraised with standard review criteria. The consistency of evidence across studies was assessed. A conceptual framework was designed to classify the literature according to methodologic quality, target population, and phases of investigation. RESULTS: Thirteen cohort studies were included in the review. The framework used in this study demonstrates that most of the recent prognostic studies are descriptive in nature. The prognosis of acute whiplash varies according to the population sampled and the insurance/compensation system under which individuals are allowed to claim benefits. Besides age, gender, baseline neck pain intensity, baseline headache intensity, and baseline radicular signs and symptoms, there is little consistency in the literature about the prognostic factors for the recovery of whiplash. CONCLUSIONS: Scant knowledge about the prognosis of whiplash has been gained since the release of the Quebec Task Force report. However, it is becoming obvious that the insurance and compensation systems have a large impact on recovery from acute whiplash injuries. The conceptual framework used in this study demonstrates that large cohort studies investigating a wide range of prognostic factors are necessary to improve the understanding of this problem.

Concept Formation↗

PubMed2026

Molecular profiling of coronary stent testenosis: A systematic review and functional analysis of implicated genes.

BACKGROUND: Coronary stent restenosis occurs in approximately 5% of patients treated with drug-eluting stents (DES) and is associated with adverse clinical outcomes. Elucidating the genetic mechanisms underlying restenosis may support precision medicine approaches to improve patient management.This systematic review aimed to synthesize evidence on genes and biological pathways associated with DES-related restenosis and to perform functional analysis of the implicated genes using bioinformatics tools. METHODS: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search of PubMed, Scopus, and Web of Science was performed for human studies investigating genetic or genomic factors in coronary restenosis, with the last search conducted in March 2024. Eligibility criteria included original studies reporting genetic associations with DES restenosis. Screening and data extraction were performed by a single reviewer. Identified genes underwent gene set enrichment analysis using Enrichr (Ma'ayan Laboratory, Computational Systems Biology) and ClueGo extension on Cytoscape (National Resource for Network Biology). RESULTS: Seventeen studies met the inclusion criteria. The studies highlighted multiple genes involved in extracellular matrix remodeling, inflammatory signaling, and the renin-angiotensin system. Gene enrichment analysis confirmed the overrepresentation of these biological pathways in DES-associated restenosis. CONCLUSIONS: This systematic review synthesizes the genetic and molecular contributors to DES-associated restenosis and identifies potential targets for future research and personalized therapies. No external funding was received, and the protocol was not registered.

Humans↗

PubMed2026

Proficiency-based training and evidence-based methodology: a systematic review and meta-analysis.

OBJECTIVE: To assess adherence of self-labelled proficiency-based progression (PBP) studies to evidence-based PBP criteria and examine associations with training outcomes. METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews. PubMed, CENTRAL, EMBASE, MEDLINE, and Scopus were searched from inception to 1 March 2023. Prospective English-language studies on healthcare procedural training reporting objective performance outcomes were included; non-prospective, non-quantitative, non-procedural, non-English studies, and reviews were excluded. Pre-specified outcomes included adherence to 18 evidence-based PBP criteria and objective performance metrics (errors, steps, time); secondary outcomes included proficiency benchmark achievement and Likert ratings. Data extraction was performed independently by multiple reviewers. Study quality was assessed using the Medical Education Research Study Quality Instrument and risk of bias by two investigators. Effect sizes were pooled using random-effects models (DerSimonian-Laird), expressed as the ratio of means (ROM) for continuous outcomes and bias-corrected odds ratios for dichotomous outcomes. RESULTS: Of 646 studies identified 175 met inclusion criteria. In the PBP studies (n = 18), 94% fulfilled minimum criteria (use of a proficiency benchmark, its quantitative definition, and requirement for demonstration prior to progression) vs 36% of non-PBP studies (n = 157). If all PBP criteria were included, 83% of PBP studies used these criteria vs only 2% of non-PBP-studies. In quantitative analysis (27 randomised clinical studies, 761 participants), ROM results showed that PBP training reduced the number of performance errors by 58% (P < 0.001) and procedural time by 28% (P = 0.006), increasing number of steps performed by 22% (P = 0.03). When stratified based on number of criteria fulfilled, meta-regression demonstrated that increasing the number of PBP criteria fulfilled was associated with progressive and systematic trainee performance improvement. CONCLUSIONS: The more training methodologies adhere to established PBP criteria, the better training outcome will be.

Humans↗

PubMed2026

Prostate morcellation devices: a systematic review and meta-analysis of clinical outcomes and efficiency.

OBJECTIVE: To systematically evaluate the efficiency and safety of different prostate morcellators used during prostate enucleation for benign prostatic hyperplasia (BPH). METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. PubMed/Medline, Scopus, and Web of Science were searched for studies published between October 2012 and May 2025. Studies reporting clinical outcomes of morcellators used during prostate enucleation were included. Primary outcome was morcellation efficiency (g/min). Secondary outcomes included intraoperative complications, device malfunction, and cost when available. Risk of bias (RoB) was assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I), RoB 2 tool, and European Association of Urology case-series criteria. Random-effects meta-analyses and multilevel meta-regression adjusted for prostate volume were conducted. RESULTS: A total of 22 studies comprising 5980 patients were included, most undergoing holmium laser enucleation of the prostate. The most frequently evaluated devices were the Piranha™ (Richard Wolf GmbH, Knittlingen, Germany) and Lumenis VersaCut™ (Lumenis Ltd., Yokneam, Israel; 12 and 13 studies, respectively), followed by DrillCut™ (Karl Storz SE & Co. KG, Tuttlingen, Germany), MultiCut™ (Asclepion Laser Technologies GmbH, Jena, Germany), and Cyber Blade™ (Quanta System SpA, Milan, Italy) systems. Unadjusted weighted mean morcellation efficiency was 7.80 g/min (95% confidence interval [CI] 6.26-9.34 g/min) for Piranha, 4.70 g/min (95% CI 3.61-5.79 g/min) for VersaCut, 5.90 g/min (95% CI 3.16-8.64 g/min) for DrillCut, and 9.59 g/min (95% CI 4.78-14.39 g/min) for MultiCut. In volume-adjusted meta-regression using Piranha as reference, VersaCut remained significantly less efficient (-2.75 g/min; 95% CI -4.58 to -0.92 g/min; P = 0.003), with an even greater difference in prostates >70 mL (-4.34 g/min). Bladder mucosal injury was the most frequently reported complication; however, relatively rare across all devices. Meta-analysis demonstrated a significantly higher risk with VersaCut compared to Piranha (risk ratio 3.22, 95% CI 1.81-5.71), with low heterogeneity. CONCLUSION: This systematic review provides a contemporary clinical benchmark of the efficiency and safety of currently available prostate morcellators. Oscillating blade systems, particularly the Piranha morcellator, demonstrated higher morcellation efficiency and a more favourable safety profile than reciprocating blade devices, with the largest performance differences observed in patients with larger prostates.

Humans↗

PubMed2004

Systematic review of the literature on postpartum care: methodology and literature search results.

BACKGROUND: The postpartum period is a time for multiple clinical interventions. To date, no critical review of these interventions exists. This systematic review examined evidence for the effectiveness of postpartum interventions that have been reported in the literature. METHODS: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women that were conducted in North America, Europe, Australia, or New Zealand. The initial literature search was done in 1999, using postpartum content search terms, and was enhanced in 2003. In both years, bibliographic databases were searched from their inception. Studies were categorized into key topic areas. Data extraction forms were developed and completed for each study, and the quality of each study was systematically reviewed. Groups of studies in a topic area were reviewed together, and clinically relevant questions emanating from the studies were identified to determine whether the studies, alone or together, provided evidence to support the clinical intervention. RESULTS: In the 1999 search, of 671 studies identified, 140 studies were randomized controlled trials that met the selection criteria: 41 studies related to breastfeeding, 33 to postpartum perineal pain management, and 63 to 11 other key topic areas (Papanicolaou test, rubella immunization, contraception, postpartum support, early discharge, postpartum depression and anxiety, postpartum medical disorders, smoking cessation, nutrition supplements other than breastfeeding, effects of pelvic floor exercise, and effects of early newborn contact). The results of the systematic review of each topic will be summarized in separate papers as they are completed. CONCLUSIONS: This systematic search has identified key topic areas in postpartum care for which randomized controlled trials have been conducted. Our ultimate goal is to provide evidence-based guidelines on the use of routine postpartum interventions.

Breast Feeding↗

PubMed2005

Effects of timed voiding for the management of urinary incontinence in adults: systematic review.

AIM: The aim of this paper is to present a systematic review assessing the effectiveness of timed voiding for the management of urinary incontinence in adults. BACKGROUND: Despite the widespread use of systematic voiding programmes, their effectiveness is unclear, and the evidence for timed voiding has not been subject to rigorous and systematic evaluation. The impact on psychosocial factors and cost is also untested. The physiological basis for timed voiding is also poorly established. METHODS: The systematic review incorporated the methodology of the Cochrane Collaboration. All randomized or quasi-randomized controlled trials that addressed timed voiding for the management of urinary incontinence in adults were searched, appraised, analysed and summarized. The date of the latest search was 2002. Data were extracted independently and appraised according to the level of concealment of random allocation prior to formal entry; few and identifiable withdrawals and dropouts and an analysis based on an intention to treat. The relative risk for dichotomous data was calculated with 95% confidence intervals. Where data were insufficient to support quantitative analysis, a narrative overview was undertaken. RESULTS: Two trials of timed voiding met the inclusion criteria. In both, timed voiding was combined with other strategies. Participants were predominantly cognitively and physically impaired older women who resided in nursing home settings. Within-group improvements for the intervention groups were reported for both trials. One trial additionally reported a statistically significant reduction in night-time incontinence for the intervention group. The quality of the trials was modest and interpretation was limited by the potential for bias associated with inadequate concealment, missing data and no analysis by intention to treat. CONCLUSION: Terms used to describe voiding programmes that involve a fixed interval of voiding are variable. No conclusions can be drawn at this point about the effectiveness of timed voiding for the management of urinary incontinence in adults.

Aged, 80 and over↗

PubMed2006

A systematic review on communicating with patients about evidence.

OBJECTIVE: To conduct a systematic search for (1) the effectiveness of evidence-based communication tools to increase patient understanding of evidence, (2) effective formats for representing probabilistic information and (3) effective strategies for eliciting patient preferences about evidence. A case scenario is used to illustrate some of the difficulties of putting these results into practice. DATA SOURCES: Systematic search of The Cochrane Library, Medline, Psychinfo, Embase and Cancerlit. REVIEW METHODS: Systematic reviews of randomized controlled trials (RCTs) and high quality RCTs were included. Studies were excluded if they did not address the question, were focused on behavioural outcomes without attempting to increase understanding, were concerned with counselling as a therapeutic intervention, or were specific to communication regarding clinical trial participation. RESULTS: We found 10 systematic reviews of RCTs and 30 additional RCTs addressing our questions. Communication tools in most formats (verbal, written, video, provider-delivered, computer-based) will increase patients' understanding but are more likely to do so if structured, tailored and/or interactive. Probabilistic information is best represented as event rates (natural frequencies) in relevant groups of people, rather than words, probabilities or summarized as effect measures such as relative risk reduction. Illustrations such as cartoons, or graphs (vertical bar charts) appear to aid understanding. Values clarification exercises may be better than standard utility techniques for eliciting preferences in individual decision making. Looking for effective evidence-based communication tools for prostatic specific antigen testing highlighted the challenges for clinicians and consumers in accessing tools that are evidence-based in design as well as content. CONCLUSION: There is an increasing body of evidence supporting the design of effective evidence-based communication tools but variable access to such tools in practice.

Communication↗

PubMed2006

Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease - evidence from systematic reviews of randomized controlled trials (second update, January 2006).

AIM: To update dietetic guidelines based on systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention). METHODS: The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to January 2005 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomized controlled trials relating to diet and secondary prevention of CVD. Each review was critically appraised by at least two members of the UK Heart Health and Thoracic Dietitians Group. The quality and results of each review were discussed and summarized at a group meeting. RESULTS: Evidence-based strategies that reduce cardiovascular events in those with CVD include reduction in saturated fat and substitution with unsaturated fats. Individuals who have suffered a myocardial infarction may also benefit from adopting a Mediterranean type diet and increasing intake of omega 3 fats, but it is not clear whether they are beneficial for all patients with CVD. There is no systematic review evidence to support the use of antioxidant vitamins supplements, low glycaemic index diets, or homocysteine lowering therapies in this group. CONCLUSION: There remains good evidence that reducing saturated fat reduces morbidity in patients with CVD. This advice is consistent for most manifestations of CVD, with the addition of Mediterranean dietary advice and increased omega 3 fats for those who have had a myocardial infarction.

Antioxidants↗

PubMed2006

A systematic review of depression and mental illness preceding Parkinson's disease.

Depression has been reported in several studies to be more common in Parkinson's disease (PD) patients than in the general population, and there may be overlap in the pathophysiology of the two conditions. Anxiety and other mental disorders have also been examined for possible association with PD because of their effects on the brain. MEDLINE, EMBASE and PSYCHINFO databases were searched systematically for existing systematic reviews or meta-analyses and primary research articles. Past studies and reviews have focused on co-morbidity of depression or mental disorders and PD, but as yet there have been no systematic reviews of the evidence that these conditions precede PD. Articles without robust methodology were excluded by specified criteria, based on published quality scoring criteria. Three cohort studies, one nested case-control study, and 10 case-control studies are included in the current systematic review. Premorbid depression was significantly more common in PD patients than in those without a diagnosis of PD in five of six case-control studies and three cohort studies. Premorbid anxiety may also be associated with PD although the evidence was not as strong. A few studies have looked at dementia as a co-morbid or sequel, but never as a predictor of PD.

Depression↗