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Results for “Systematic Review”

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PubMed2005

Intermittent claudication: functional capacity and quality of life after exercise training or percutaneous transluminal angioplasty--systematic review.

PURPOSE: To systematically review published data about the short- and long-term effects of exercise training and angioplasty on functional capacity and quality of life of patients with intermittent claudication. MATERIALS AND METHODS: Articles published between January 1980 and February 2003 were included if patients had intermittent claudication treated with exercise training or angioplasty and if both functional capacity and quality-of-life scores from Medical Outcomes Study 36-Item Short Form health survey were reported for at least 3 months of follow-up. Data were pooled by using a random effects model and weighted means. Pooled results were compared between the treatment groups by using the chi2 test and the Student t test (alpha = .05, two sided). RESULTS: In the analyses, five studies (202 patients) were included in the exercise group, and three studies (470 patients), in the angioplasty group. At 3 months of follow-up, the ankle-brachial index was significantly improved in the angioplasty group (mean change, 0.18; P < .01) but not in the exercise group (mean change, 0.01; P = .29). At 3 months, quality of life was significantly improved with regard to ratings of physical functioning and bodily pain in the exercise group (mean change, 18 and 10, respectively; P < .01) and physical role functioning in the angioplasty group (mean change, 30; P = .03). Mean change in ankle-brachial index significantly differed between the two treatment groups at 3 and 6 months (P < .01); mean change in quality-of-life scores did not. CONCLUSION: Improvement in quality of life was demonstrated after both exercise training and angioplasty, whereas functional capacity showed significant improvement after angioplasty. The ankle-brachial index significantly differed between the two treatment groups at 3 and 6 months, whereas the quality-of-life scores did not.

Angioplasty, Balloon↗

PubMed2006

Pharmacotherapy for the treatment of aggressive behavior in general adult psychiatry: A systematic review.

OBJECTIVE: To systematically review the evidence for pharmacologic management of outwardly directed aggressive behavior in general adult psychiatry. DATA SOURCES: Literature searches in PubMed, EMBASE, PsycINFO, and Cochrane libraries from 1966 through March 2005 were used to identify relevant studies. The keywords aggression, violence, anger, and hostility combined with drug therapy, psychotropic drugs, adrenergic beta-antagonists, anticonvulsants, anti-depressants, antipsychotic agents, benzodiazepines, and lithium were searched. Furthermore, the retrieved publications were searched for additional references. STUDY SELECTION: All randomized controlled trials addressing pharmacotherapy for aggression or aggression-related symptoms were included, except studies addressing the "emergency situation" and studies conducted in specialized psychiatric or non-psychiatric settings. DATA EXTRACTION: Evidence synthesis was performed using the "best-evidence principle." Two authors independently adjudicated methodological quality and generalizability to daily clinical practice. DATA SYNTHESIS: Thirty-five randomized controlled trials met the inclusion criteria and were evaluated. On the basis of a best-evidence synthesis model, weak evidence for antiaggressive effects of antipsychotics, anti-depressants, anticonvulsants, and beta-adrenergic-blocking drugs was found. Atypical antipsychotics appeared superior to typical antipsychotics. The use of various outcome measures and insufficient data reporting in the individual studies hampered the quantitative assessment of efficacy across studies. Further limitations of the available randomized controlled trials included small sample sizes, short study duration, and poor generalizability to daily clinical practice setting. CONCLUSIONS: Whereas pharmacotherapy is frequently applied in aggressive patients, only weak evidence of efficacy of various drug classes was found. Consensus about the use of aggression measurement scales in clinical trials is necessary for future research. Furthermore, large-scale trials with more naturalistic designs, as opposed to classical randomized controlled trials with strict inclusion and exclusion criteria, may be advisable in order to obtain results that are more generalizable to daily clinical practice.

Adolescent↗

PubMed2006

Medicinal and injection therapies for mechanical neck disorders: a Cochrane systematic review.

OBJECTIVE: To systematically review randomized trials on medicines and injections used to improve pain, function/disability, and patient satisfaction in adults with mechanical neck disorders (MND) with or without associated headache or radicular findings. METHODS: We searched CENTRAL (Issue 4, 2002), and MEDLINE, EMBASE, MANTIS, CINHAL from their start to March 2003. Two authors independently selected articles, abstracted data, and assessed methodological quality using the Jadad criteria. When clinical heterogeneity was absent, we combined studies using random-effects metaanalysis models. RESULTS: Thirty-two selected trials had an overall methodological quality of mean 3.2/5. For acute whiplash, administering intravenous methylprednisolone within 8 hours reduced pain at one week [SMD -0.90 (95% CI -1.57 to -0.24)], and sick leave but not pain at 6 months compared to placebo. For chronic MND at short-term followup, intramuscular injection of lidocaine was superior to placebo [SMD 1.36 (95% CI -1.93 to -0.80)]. In chronic MND with radicular findings, epidural methylprednisolone and lidocaine reduced neck pain [SMD -1.46 (95% CI -2.16 to -0.76)] and improved function at one-year followup compared to the intramuscular route. In subacute/chronic MND, we found conflicting evidence for oral psychotropic agents. In chronic MND with or without radicular findings or headache, there was moderate evidence from 5 high quality trials showing that botulinum toxin (Botox A) intramuscular injections were not better than saline in improving pain [SMD pooled -0.39 (95% CI -1.25 to 0.47)], disability, or global perceived effect. CONCLUSION: Intramuscular injection of lidocaine for chronic MND and intravenous injection of methylprednisolone for acute whiplash were effective treatments. There was limited evidence of effectiveness of epidural injection of methylprednisolone and lidocaine for chronic MND with radicular findings. Muscle relaxants and nonsteroidal antiinflammatory drugs have unclear benefits. There was moderate evidence that Botox-A intramuscular injections for chronic MND were not better than saline.

Administration, Oral↗

PubMed1999

Clinical performance of CEREC ceramic inlays: a systematic review.

OBJECTIVE: This systematic review of clinical trials seeks to identify the clinical performance of intra-coronal CEREC restorations luted with an adhesive composite technique. The focus of the review is to establish the survival rate of these restorations and to identify the factors that may cause them to fail. METHOD: A comprehensive literature search was undertaken, spanning from the year of introduction of the technology--1986 to 1997. This review identifies universal indicators of the clinical performance of intra-coronal CEREC restorations luted with an adhesive composite technique. Throughout the critical appraisal, each individual study was analysed identifying the aims, the methodology and materials used and the results obtained. RESULTS: 29 clinical reports were identified in the search. The systematic analysis reduced the focus of review to 15 studies. The data available establishes ceramic intra-coronal restorations machined by the CEREC system as a clinically successful restorative method with a mean survival rate of 97.4% over a period of 4.2 years. The review also highlights the reasons and the rates of failure for this type of restoration. The predominant reasons for failures are fracture of the ceramic, fracture of the supporting tooth, postoperative hypersensitivity and wear of the interface lute. SIGNIFICANCE: Machinable ceramics, as used by the CEREC system provide a useful restoration with a high success rate. These restorations are color stable and wear at a clinically acceptable rate. Wear of the luting composite on occlusal surfaces leads to the phenomenon of submargination. Ceramic fracture, wear at the interface and post-operative hypersensitivity remain a problem which require further investigation.

Ceramics↗

PubMed2026

Neuroimaging anxious children and adolescents before and after cognitive behavioral therapy: a systematic review.

OBJECTIVE: This systematic review investigates brain changes in youths with anxiety disorders following cognitive behavioral therapy (CBT) and neural markers that predict CBT responses. METHODS: We conducted a systematic search using the electronic databases PubMed, Web of Science, and ProQuest. The inclusion deadline was set to October 27, 2025. We included fifteen peer-reviewed neuroimaging studies that examined the effects of CBT in youths under 19 years old with a primary clinical diagnosis of an anxiety disorder based on DSM-5 criteria. RESULTS: Although the existing literature is marked by substantial diversity in methods and outcomes, task-related neural response in the anterior cingulate cortex (ACC, 2/8, 25.0%), insula (1/8, 12.5%) increased from pre to post CBT and these changes were further correlated with clinical symptom improvements. Moreover, CBT outcomes were predicted by pre-treatment activity or connectivity in the ACC and amygdala (3/13, 23.0%). A smaller proportion of studies (2/13, 15.3%) found that activity or connectivity in the insula, precuneus/cuneus, postcentral gyrus, and activity or structure in the nucleus accumbens (NAcc) predicted response to CBT. The low consistency of these findings was driven by methodological variability, low reliability of the neural markers, and relatively small sample sizes. CONCLUSIONS: This review highlights promises of neural predictors and outcomes to enhance anxiety disorder treatments in children and adolescents, facilitating future personalized and effective CBT. Beyond this initial promise, the field is hindered by methodological inconsistencies and limited replications. While longitudinal and personalized approaches are important next steps, the central challenge remains: identifying neural markers that are both reliable and robust.

Adolescent↗

PubMed2006

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

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

Aged↗

PubMed2003

Physical therapy for pregnancy-related low back and pelvic pain: a systematic review.

BACKGROUND: A systematic review of prospective controlled clinical trials was performed to assess the effectiveness of physical therapy interventions for the prevention and treatment of pregnancy-related back and pelvic pain. Pregnancy-related low back and pelvic pain has an impact on daily life for many women. Prevention and treatment of back and pelvic pain is therefore an important issue for all those concerned with women's health. METHODS: All prospective controlled clinical trials retrieved by systematic searching of electronic databases, checking of reference lists and contacting of authors were examined. Two reviewers independently selected trials for inclusion and independently assessed the internal validity of the included trials. Authors were contacted to obtain missing information. RESULTS: Nine trials with a total of 1350 patients were reviewed. Except for three high-quality studies, the validity of the trials was moderate to low. Two high-quality studies showed no difference in pain intensity and functional status between the exercise groups and the control groups. In the third high-quality study significant reduction in sick leave was found in favor of water gymnastics compared with no intervention. Because the included trials were considered heterogeneous with regard to study design, population intervention and outcome, no meta-analysis was performed. CONCLUSIONS: Because of heterogeneity and the varying quality of the studies no strong evidence exists concerning the effect of physical therapy interventions on the prevention and treatment of back and pelvic pain related to pregnancy. Future studies should meet current methodological standards, and interventions to be evaluated should be based on established theoretical framework.

Female↗

PubMed2005

Evaluation of effective return-to-work treatment programs for sick-listed patients with non-specific musculoskeletal complaints: a systematic review.

OBJECTIVE: This systematic review seeks to gain insight into the effectiveness of return-to-work treatment programs among sick-listed patients with non-specific musculoskeletal complaints. The focus here lies on the composition of effective treatment programs, itemized for regional non-specific musculoskeletal complaints. METHODS: A systematic literature search was performed and methodological quality criteria were applied. RESULTS: Eighteen high quality articles were selected, which reported on a combined total of 22 treatment programs, including a total of 3,579 participants. Of these 22 treatments programs, seven experimental treatments (32%) resulted in faster return to work compared to the control treatment. None of the studies reviewed reported negative findings. What appeared to be essential to effective treatment was knowledge conditioning, psychological, physical and work conditioning, possibly supplemented with relaxation exercises. Most of the high quality studies (64%) reported on a low back pain population. CONCLUSION: The findings were inconsistent regarding the effectiveness of treatment programs in enabling sick-listed patients with non-specific musculoskeletal disorders to return to work. Except for low back pain, none of the studies explicitly itemized the effects of treatment programs on return to work by regional musculoskeletal disorders, such as upper extremity musculoskeletal disorders.

Humans↗

PubMedDate not supplied

Taking advantage of the explosion of systematic reviews: an efficient MEDLINE search strategy.

CONTEXT: Systematic reviews of the literature are an important resource for clinicians. Unfortunately, the few published strategies for identifying these articles involve MEDLINE interfaces not widely available outside of academic medicine. In addition, the performance of these strategies is unknown. OBJECTIVE: To develop and evaluate a search strategy for identifying systematic reviews by using a publicly available MEDLINE interface (PubMed). DESIGN: Diagnostic test assessment. DEFINITION OF SENSITIVITY: The proportion of recognized systematic reviews (indexed in the Cochrane Library's Database of Abstracts of Reviews of Effectiveness [DARE] or in ACP Journal Club) that are identified by the search strategy. DEFINITION OF POSITIVE PREDICTIVE VALUE: The proportion of articles identified in one of three sample searches (screening for colorectal cancer, thrombolytic therapy for venous thromboembolism, and treatment of dementia) that meet a minimum definition of systematic review. RESULTS: Our PubMed search strategy identified 93 of 100 DARE-indexed systematic reviews, a sensitivity of 93% (95% CI, 86% to 97%). For the sample of systematic reviews drawn from ACP Journal Club (n = 103), the PubMed strategy achieved a sensitivity of 97% (CI, 91% to 99%). When the three sample search strings were used, approximately 50% of retrieved articles met our minimum definition of systematic review. In contrast, the similar precision of a PubMed search restricted to review-type articles (as indexed by MEDLINE) was less than 10%. CONCLUSIONS: This search strategy identified most systematic reviews without over-whelming users with numerous false-positive results. A "single-click" filter based on this strategy is now available as part of the Clinical Queries feature of PubMed.

Evidence-Based Medicine↗

PubMed2003

Evaluating systematic reviews and meta-analyses.

Systematic review and meta-analysis procedures make use of explicit methods to methodically search and critically appraise and synthesize the medical care research literature. The methods involve refining a clinical question, designing a search procedure to find eligible studies, and determining the validity of the eligible studies. Independent data extraction by two or more reviewers is preferred. Agreement between the reviewers with respect to relevance and validity should be measured. Meta-analysis procedures estimate an overall average effect from the individual study effects and determine whether these effects appear to measure the same relationship (that is, the studies are not heterogeneous). In the inverse variance method, which is most frequently applied, the overall effect is a weighted average of the individual study effects, where each weight is the inverse of the study variance. To evaluate a systematic review, first determine whether it addresses a question that is relevant to the patients, treatments, and outcomes that are usual in your clinical practice. Then assess the validity of the systematic review, which is reflected by quality of the individual studies, the rigor with which the systematic methods were applied, and the extent of heterogeneity. If the results of the systematic review are valid, then is the effect important enough to make a difference in your clinical practice? Applying the results to an individual patient involves the absolute treatment effect or the number needed to treat, and an awareness of the patient's specific level of risk and personal preferences.

Data Interpretation, Statistical↗

PubMed2006

Methodological quality of systematic reviews of animal studies: a survey of reviews of basic research.

BACKGROUND: Systematic reviews can serve as a tool in translation of basic life sciences research from laboratory to human research and healthcare. The extent to which reviews of animal research are systematic and unbiased is not known. METHODS: We searched, without language restrictions, Medline, Embase, bibliographies of known reviews (1996-2004) and contacted experts to identify citations of reviews of basic science literature which, as a minimum, performed search of a publicly available resource. From these we identified reviews of animal studies where laboratory variables were measured or where treatments were administered to live animals to examine their effects, and compared them with reviews of bench studies in which human or animal tissues, cell systems or organ preparations were examined in laboratories to better understand mechanisms of diseases. RESULTS: Systematic reviews of animal studies often lacked methodological features such as specification of a testable hypothesis (9/30, 30%); literature search without language restriction (8/30, 26.6%); assessment of publication bias (5/30, 16.6%), study validity (15/30, 50%) and heterogeneity (10/30, 33.3%); and meta-analysis for quantitative synthesis (12/30, 40%). Compared to reviews of bench studies, they were less prone to bias as they specified the question (96.6% vs. 80%, p = 0.04), searched multiple databases (60% vs. 26.6%, p = 0.01), assessed study quality (50% vs. 20%, p = 0.01), and explored heterogeneity (33.3% vs. 2.2%, p = 0.001) more often. CONCLUSION: There seems to be a gradient of frequency of methodological weaknesses among reviews: Attempted systematic reviews of whole animal research tend to be better than those of bench studies, though compared to systematic reviews of human clinical trials they are apparently poorer. There is a need for rigour when reviewing animal research.

Animal Experimentation↗

PubMed2000

Recent economic evaluations of antenatal screening: a systematic review and critique.

A systematic review of recent economic evaluations of antenatal screening was conducted. Relevant studies were identified from a number of sources including computerised databases, bibliographies of economic evaluations, and searches of unpublished manuscripts. Each study identified by the literature searches was categorised on the basis of its title and abstract. Studies considered relevant to the systematic review were obtained from libraries. The methodology, results, and policy implications of studies categorised as economic evaluations upon full review were documented. A total of 566 studies were identified by the literature searches, 41 of which were categorised as economic evaluations upon full review. The economic evaluations covered a range of antenatal screening practices, aimed mainly at the prevention of infectious diseases and fetal anomalies. The review highlighted the poor methodological quality of the bulk of economic evaluations of antenatal screening. The study design, data collection methods, and analysis and interpretation of results frequently violated methodological guidelines adopted by health economists. The review also highlighted the narrow definition of benefits adopted by this body of literature, with most studies reporting outcomes in terms of cases detected, cases of particular disorders prevented or, most often, costs averted. The conclusions arrived at differed by area of antenatal screening. There appeared to be clear economic arguments in favour of some forms of antenatal screening, for example, triple test screening for Down's syndrome. Other economic evaluations pertained to specific locations, which suggests that the results may not necessarily be generalizable to different settings. For all areas of antenatal screening, an updating of published economic evaluations may be required to account for evolving economic, epidemiological, and clinical effectiveness evidence.

Costs and Cost Analysis↗

PubMed2006

The effect of low-Dye taping on kinematic, kinetic, and electromyographic variables: a systematic review.

STUDY DESIGN: A systematic review. OBJECTIVE: To determine the strength of evidence of the effect of low-Dye taping on lower limb kinematic, kinetic, and electromyographic variables. BACKGROUND: Low-Dye taping is a foot-taping technique that aims to limit foot pronation and is commonly used to treat a number of foot disorders. METHODS AND MEASURES: Systematic review of randomized or quasi-randomized trials examining the effect of low-Dye taping compared with no taping on kinematic, kinetic, and electromyographic variables. Trials were identified by searching CINAHL, EMBASE, MEDLINE, SPORTDiscus, and CENTRAL, and by recursive checking of bibliographies. Data were extracted from published trials and from mail contact with authors for further information as necessary. Meta-analyses were planned for all outcomes using the generic inverse variance method. Sensitivity analyses were planned by pooling data from nonrandomized trials. Statistical heterogeneity was assessed using the quantity I2. RESULTS: Six trials met inclusion criteria and, of these, 5 trials reported sufficient data on kinematic and kinetic variables to be included in the analysis. Results from the 5 randomized trials were considered robust when pooled with data from 7 nonrandomized trials in a sensitivity analysis. When compared to no taping, low-Dye taping increased navicular height immediately after application (weighted mean difference [WMD], 5.90 mm; 95% confidence interval [CI], 0.41 to 11.39; P = .04) and had no effect on navicular height post exercise (WMD, 4.70 mm; 95% CI, -0.61 to 10.01; P = .08), maximum rearfoot eversion while walking (WMD, -0.59 degrees; 95% CI, -2.53 to 1.35; P = .55), and total rearfoot range of motion while walking (WMD, 2.3 degrees; 95% CI, -0.64 to 5.24; P = .13). CONCLUSIONS: Low-Dye taping provides a small change in navicular height post application, although it is unclear whether this change is clinically important. There was high heterogeneity between some trials examining other variables, indicating that more research is needed to confirm the results of previous trials.

Adolescent↗

PubMed2006

Incidence of schizophrenia does not vary with economic status of the country: evidence from a systematic review.

BACKGROUND: A recent systematic review found that the prevalence of schizophrenia was lower in developing nations compared to developed nations. However, there is a lack of information about the association between economic status and the incidence of schizophrenia. The aim of this study was to examine the association between economic status and the underlying incidence of schizophrenia based on a recently published systematic review of the incidence of schizophrenia. METHODS: The analyses were based on 167 discrete incidence rates from 52 studies. Nations were divided into three categories according to per capita gross national product. Based on these categories, we compared the incidence rates for schizophrenia when adjusted for within-study variation. RESULTS: The median (and 10-90% quantiles) incidence rates per 100,000 persons for Least Developed Countries (three studies), Emerging Economies (nine studies), and Developed Countries (42 studies) were 20.0 (0.4-35.0), 11.0 (5.0-26.0) and 16.0 (8.0-48.0) respectively. There was no significant difference in incidence rates between these groups. CONCLUSIONS: While there is a lack of information on the incidence of schizophrenia in the developing world, there is no evidence to suggest that the incidence of schizophrenia varies by economic status. In light of the evidence that the prevalence of schizophrenia is higher in developed countries, more research is warranted focused on the interaction between economic measures, and the incidence, prevalence and course of schizophrenia.

Developed Countries↗

PubMed2002

Dorsal root entry zone lesioning used to treat central neuropathic pain in patients with traumatic spinal cord injury: a systematic review.

STUDY DESIGN: A systematic review was conducted for studies of any design. OBJECTIVES: To evaluate the effectiveness and safety of dorsal root entry zone lesioning in treating central neuropathic pain of patients with traumatic spinal cord injury. SUMMARY OF BACKGROUND DATA: Central neuropathic pain has a great impact on the quality of life of many patients with traumatic spinal cord injury. Dorsal root entry zone lesioning has become one of several treatment options. No previous systematic reviews were found that address this indication for the procedure. METHODS: Several computerized databases were searched along with reference lists of eligible articles and personal files of advisory panel members. Only primary studies of patients older than 13 years with both traumatic spinal cord injury and central neuropathic pain receiving dorsal root entry zone lesioning were included. Two assessors independently performed data extraction and quality assessment for all the studies. RESULTS: The selection criteria were met by 11 studies. All were case series of 5 to 54 patients. As reported by 10 of the studies, at least 50% of the patients attained more than 50% pain relief or experienced no pain limitation of activity and no need for narcotics. However, all the studies had poorly defined eligibility criteria or none at all, no control groups, and inadequate reporting of adverse effects. Only one study provided adequate patient description. None of the studies reported the validity, reliability, or responsiveness of outcome measures. CONCLUSIONS: Reviewed studies indicate promising results from dorsal root entry zone lesioning for the treatment of central neuropathic pain in selected patients with traumatic spinal cord injury. However, the strength of the evidence provided by the studies was poor in terms of study design, outcome measures, reports on the severity of adverse effects, patient selection criteria, and patient description. For these reasons, the evidence is weak for the use of dorsal root entry zone lesioning to relieve central neuropathic pain in patients with traumatic spinal cord injury.

Adult↗

PubMed2005

Criteria for the systematic review of health promotion and public health interventions.

Systematic reviews of public health interventions are fraught with challenges. Complexity is inherent; this may be due to multi-component interventions, diverse study populations, multiple outcomes measured, mixed study designs utilized and the effect of context on intervention design, implementation and effectiveness. For policy makers and practitioners to use systematic reviews to implement effective public health programmes, systematic reviews must include this information, which seeks to answer the questions posed by decision makers, including recipients of programmes. This necessitates expanding the traditional evaluation of evidence to incorporate the assessment of theory, integrity of interventions, context and sustainability of the interventions and outcomes. Unfortunately however, the critical information required for judging both the quality of a public health intervention and whether or not an intervention is worthwhile or replicable is missing from most public health intervention studies. When the raw material is not available in primary studies the systematic review process becomes even more challenging. Systematic reviews, which highlight these critical gaps, may act to encourage better reporting in primary studies. This paper provides recommendations to reviewers on the issues to address within a public health systematic review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews.

Humans↗

PubMed2002

Why do clinicians sometimes find it difficult to use the results of systematic reviews in routine clinical practice?

Reviews of systematic results have proved enormously useful in routine clinical practice. However, the uncritical application of the overall results of systematic reviews to clinical decisions about individual patients can sometimes do more harm than good. Clinical syndromes are often complex, with considerable pathological heterogeneity, and the likely balance of the risks and benefits of interventions can be difficult to judge on an individual patient basis. Active involvement of experienced clinicians is essential in the planning, reporting, and interpretation of reviews. Detailed consideration should be given to the possibility of diagnostic or pathological heterogeneity within the clinical trials included in the review or between the trial patients and patients seen in routine clinical practice. For treatments that have significant risk of harm or treatments that are particularly costly, meta-analysis of individual patient data with stratification by baseline risk is sometimes helpful in targeting treatment appropriately in routine clinical practice.

Attitude of Health Personnel↗

PubMed2001

Medical treatment for reflux oesophagitis does not consistently improve asthma control: a systematic review.

BACKGROUND: A systematic literature review was conducted to assess the effect of treating reflux oesophagitis on asthma outcomes. METHODS: Randomised controlled trials of reflux oesophagitis treatment in adults or children that reported asthma health outcomes were included and assessed in accordance with the standard Cochrane systematic review process. Patients were typically adults with asthma and concurrent symptomatic gastro-oesophageal reflux who received interventions that included pharmacological therapy, conservative management, and surgery. The following outcome measures were assessed: lung function, peak expiratory flow, asthma symptoms, asthma medications, and nocturnal asthma. RESULTS: From 22 potentially relevant published and unpublished randomised controlled trials, 12 were included. Treatment duration ranged from 1 week to 6 months. Eight trials reported that treatment improved at least one asthma outcome, but these outcomes differed between trials. Overall, treatment of reflux oesophagitis did not consistently improve forced expiratory volume in one second (FEV(1)), peak expiratory flow rate, asthma symptoms, nocturnal asthma symptoms, or use of asthma medications in asthmatic subjects. Significant improvement in wheeze was reported in two studies. CONCLUSIONS: The published literature does not consistently support treatment of reflux oesophagitis as a means of controlling asthma. Further large randomised controlled trials in subjects with a demonstrated temporal relationship between gastro-oesophageal reflux and asthma are needed. These trials should be conducted over at least 6 months to allow adequate time to observe a treatment effect.

Adolescent↗