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PubMed2000

Alcohol and coronary heart disease: a meta-analysis.

OBJECTIVE: To estimate parameters of the function relating alcohol consumption with the risk of coronary heart disease and to identify the sources of heterogeneity in the parameter estimates. METHODS: A search of the epidemiological literature from 1966 to 1998 was performed using several bibliographic databases. Meta-regression models were fitted to evaluate non-linear effects of alcohol intake on the relative risk. The effects of some characteristics of the studies, including an index of their quality, were considered as putative sources of heterogeneity of the estimates. Publication bias was also investigated. FINDINGS: Among the 196 initially reviewed articles, 51 were selected. Since qualitative characteristics of the studies were significant sources of heterogeneity, the pooled dose-response functions were based on the 28 cohort studies with higher quality. Risk decreased from 0 to 20 g/day (RR = 0.80; 95% CI: 0.78, 0.83); there was evidence of a protective effect up to 72 g/day (RR = 0.96; 95% CI: 0.92, 1.00) and increased risk above > or = 89 g/day (RR = 1.05; 95% CI: 1.00, 1.11). Lower protective effects and harmful effects were found in women, in men living in countries outside the Mediterranean area and in studies where fatal events were used as the outcome. Evidence of publication bias for moderate intakes and of heterogeneity of the estimates across studies for higher intakes were found. CONCLUSIONS: The degree of protection from moderate doses of alcohol should be reconsidered. Further research investigating the effect of drinking patterns on the risk of coronary heart disease should be performed. Caution in making general recommendations is needed.

Alcohol Drinking↗

PubMed2003

Systematic review: peginterferon vs. standard interferon in the treatment of chronic hepatitis C.

BACKGROUND: Randomized controlled trials over the last decade have demonstrated incremental improvement in the treatment efficacy of chronic hepatitis C with combination interferon and ribavirin therapy when compared with interferon monotherapy. AIM: To perform a systematic review of clinical trials directly comparing interferon formulations to test the hypothesis that a true difference in terms of efficacy exists between standard interferon (with and without ribavirin) and peginterferon (with and without ribavirin). METHODS: A search of the on-line bibliographic databases MEDLINE and PUBMED was performed independently by two authors to identify all relevant articles. In addition, the reference sections of all relevant articles were manually searched to identify any missed articles. Quality was assessed using the Jadad scale, which is an accepted scale specific for randomized controlled trials. A priori, it was decided to include only articles with a Jadad score of three or higher in the final analysis. Data were abstracted on to pre-determined abstraction sheets. The inclusion of articles, the data abstracted and the methodological score differences were adjudicated by consensus with agreement of the authors performing the search. RESULTS: Seven citations of randomized controlled trials, comparing at least two different interferon formulations and evaluating the sustained virological response as a primary end-point, were identified. These relevant articles were abstracted, and five of the seven were found to have a Jadad score of three or higher and comprised the final set of citations reviewed. The studies consistently demonstrated that peginterferon monotherapy was superior to standard interferon, even in patients with advanced fibrosis. With regard to combination interferon therapy, only two high-quality articles compared peginterferon plus ribavirin with standard interferon plus ribavirin. Both studies demonstrated that the overall sustained virological response was statistically better with peginterferon plus ribavirin. CONCLUSIONS: On the basis of this systematic review, peginterferon-based regimens are superior to standard interferon-based regimens for the treatment of chronic hepatitis C.

Adult↗

PubMed2004

Application of data mining techniques in pharmacovigilance.

AIMS: To discuss the potential use of data mining and knowledge discovery in databases for detection of adverse drug events (ADE) in pharmacovigilance. METHODS: A literature search was conducted to identify articles, which contained details of data mining, signal generation or knowledge discovery in relation to adverse drug reactions or pharmacovigilance in medical databases. RESULTS: ADEs are common and result in significant mortality, and despite existing systems drugs have been withdrawn due to ADEs many years after licensing. Knowledge discovery in databases (KDD) is a technique which may be used to detect potential ADEs more efficiently. KDD involves the selection of data variables and databases, data preprocessing, data mining and data interpretation and utilization. Data mining encompasses a number of statistical techniques including cluster analysis, link analysis, deviation detection and disproportionality assessment which can be utilized to determine the presence of and to assess the strength of ADE signals. Currently the only data mining methods to be used in pharmacovigilance are those of disproportionality, such as the Proportional Reporting Ratio and Information Component, which have been used to analyse the UK Yellow Card Scheme spontaneous reporting database and the WHO Uppsala Monitoring Centre database. The association of pericarditis with practolol but not with other beta-blockers, the association of captopril and other angiotensin-converting enzymes with cough, and the association of terfenadine with heart rate and rhythm disorders could be identified by mining the WHO database. CONCLUSION: In view of the importance of ADEs and the development of massive data storage systems and powerful computer systems, the use of data mining techniques in knowledge discovery in medical databases is likely to be of increasing importance in the process of pharmacovigilance as they are likely to be able to detect signals earlier than using current methods.

Data Collection↗

PubMed1999

Genetic information resources: a new field for medical librarians.

The Human Genome Project is generating unprecedented quantities of new genetic information. The new discipline of bioinformatics has created many new molecular biology databanks to store the results of the Human Genome Project. This data is expected to be the information source for biomedical science in the 21st century. As molecular biology research moves out of the laboratory and becomes molecular medicine, a growing number of people need access to genetic information. Medical students, healthcare practitioners and patients need help in finding appropriate information. Medical librarians should know how to search key genetic information resources and should have a basic understanding of the type of information contained in each.

Databases, Bibliographic↗

PubMed2002

TestisBank: an internet-based gene sequence database of the testis.

The testis is a highly transcriptionally active organ with hundreds of genes expressed during different stages of spermatogenesis. Scientists working on the testis are restricted to using two sources for further information on testicular genes, GenBank and MEDLINE. However, these two databases are not completely linked and give only very little information on the cellular type of expression or whether a gene is cloned in other tissues but is also expressed in the testis. We have generated an organ-specific database named TestisBank, which is capable of retrieving a more complete set of genes expressed in the different cell types of the testis. Furthermore, it extends to the epididymis which plays an important role in germ cell maturation. TestisBank is automatically updated to match the current status of sequence entries in the genome databases and it provides the user with an interface convenient to handle and provides useful links related to male reproduction. The TestisBank is publicly available at http://medweb.uni-muenster.de/TestisBank/. The design of the TestisBank may provide a simple model for the development of databases in which molecular and literature data are merged, thereby allowing detailed insight into the contribution of different cells/genes to the complex process of spermatogenesis.

Databases, Bibliographic↗

PubMed2002

A literature review of dementia care mapping: methodological considerations and efficacy.

Dementia care mapping (DCM) is a popular method for evaluating the quality of care and well-being of people with dementia in formal care settings. Keywords and thesaurus searches were conducted between 1992 and June 2001 using a range of bibliographic databases. Studies that had specifically examined the efficacy of DCM or, had used DCM as the main outcome measure, were included in the review. Nine studies met the inclusion criteria and were evaluated in this review. The review highlights some methodological limitations in the DCM studies to date, including sampling bias, inadequate sample size, short evaluation periods and a lack of consideration of the confounding variables commonly associated with dementia. The evidence presented for DCM suggests that it has good face validity and reliability. However, other aspects of validity remain less convincing and it can only be regarded as a moderately valid instrument. Whilst its theoretical background makes DCM particularly appealing to nurses wishing to improve the quality of their care, it is a very time-consuming method and requires considerable investment in terms of nursing resources. Consequently, it is essential that more scientifically based studies are conducted to enable other aspects of validity to be developed, thus enhancing the value of DCM as an outcome measure of nursing care.

Critical Pathways↗

PubMed2002

Hepatitis C: an epidemiological review.

The aim of the study was to analyse the current literature regarding the mode of transmission of HCV and its global prevalence in different groups of people. A systematic review of the literature on the epidemiology of hepatitis C from 1991 to 2000 using computerized bibliographic databases which include Medline, Current Content and Embase. The prevalence of hepatitis C virus (HCV) varies tremendously in different parts of the world, with the highest incidence in the Eastern parts of the globe compared with the Western parts. Furthermore, certain groups of individuals such as intravenous drug users are at increased risk of acquiring this disease irrespective of the geographical location. Although the main route of transmission is via contaminated blood, curiously enough in up to 50% of the cases no recognizable transmission factor/route could be identified. Therefore, a number of other routes of transmission such as sexual or household exposure to infected contacts have been investigated with conflicting results. Hepatitis C infection is an important public health issue globally. Better understanding of routes of transmission will help to combat the spread of disease. In order to prevent a world wide epidemic of this disease, urgent measures are required to (i) develop a strategy to inform and educate the public regarding this disease and (ii) expedite the efforts to develop a vaccine.

Global Health↗

PubMed2001

Giving tape recordings or written summaries of consultations to people with cancer: a systematic review.

OBJECTIVE: To examine the effects of providing recordings or summaries of consultations to people with cancer and their families. DESIGN: Systematic review. DATA SOURCES: MEDLINE, CINAHL, Cancerlit, EMBASE and other electronic bibliographic databases. Bibliographies of relevant papers. SELECTION CRITERIA: Randomized and non-randomized controlled trials of the provision of taped recordings or written summaries of consultations to people with cancer and/or their families. MAIN RESULTS: Eight randomized controlled trials were found, all involving adult participants. No non-randomized controlled trials were found. The quality of the studies was generally poor. Between 83% and 96% of people who received recordings or summaries found them useful to remind them of what was said and/or to inform family members and friends about their illness and treatment. Of seven studies that assessed recall of information given during the consultation, four reported better recall among the groups that received recordings or summaries than among control groups. Receiving a recording or summary had no significant effect on anxiety or depression between the groups. None of the included studies assessed survival or health outcomes other than psychological outcomes. CONCLUSIONS: Wider use of consultation tapes and summary letters could benefit many adults with cancer, without causing additional anxiety or depression, but consideration should be given to individuals' circumstances and preferences.

Humans↗

PubMed2000

Hypoglycaemia induced by exogenous insulin--'human' and animal insulin compared.

AIMS: A systematic review of the literature was carried out to examine whether published evidence suggests a difference in the frequency and awareness of hypoglycaemia induced by 'human' and animal insulin. METHODS: The review identified randomized controlled trials and studies of other designs including observational comparisons, case series and case reports in which the use of 'human' insulin was compared to animal insulin in people with diabetes. These were identified from bibliographic databases and hand-searches of key journals. The main outcome measures were frequency, severity, awareness and symptoms of insulin induced hypoglycaemia. RESULTS: Fifty-two randomized controlled trials, 37 of double-blind design, were identified which included one or more of the relevant outcome measures. Of these, 21 specifically investigated hypoglycaemic frequency and awareness as primary outcomes (six in people with previously reported reduced hypoglycaemic awareness). The remainder of the identified trials reported hypoglycaemic outcomes as a secondary or incidental outcome during comparative investigations of efficacy or immunogenicity. Seven of the double-blind studies reported differences in frequency of hypoglycaemia or awareness of symptoms, although none of the studies which selected subjects on the basis of previously reported impaired awareness demonstrated significant differences between insulin species. Four of the unblinded trials reported differences in hypoglycaemia. This reached statistical significance in two of the studies. A further 56 studies of other designs and case reports were considered. In addition to the 10 case reports describing individuals with impaired hypoglycaemic awareness, nine studies reported differences in the incidence and manifestation of hypoglycaemia during 'human' insulin treatment. Notably, none of the four population time trend studies found any relationship between the increasing use of 'human' insulin and hospital admission for hypoglycaemia or unexplained death among those with diabetes. The largest case series could find no support for the hypothesis that an influence of treatment with 'human' insulin on hypoglycaemia had contributed to any of the 50 deaths investigated. When all types of studies considered are ranked in order of rigour (according to the accepted 'hierarchy of evidence'), it is the least rigorous which lend most support to the notion that treatment with 'human' insulin has an effect on the frequency, severity or symptoms of hypoglycaemia. CONCLUSIONS: Evidence does not support the contention that treatment with 'human' insulin per se affects the frequency, severity or symptoms of hypoglycaemia. However, a number of studies, mainly those of less rigorous design, describe an effect when people are transferred from animal insulin to 'human' insulin. It is not possible to state how common this is or whether the phenomenon is specific to 'human' insulin or an effect resulting from stricter glycaemic control (perhaps compounded, in some cases, by neurological complications in long-standing diabetes). This remaining uncertainty makes it essential that insulin from animal sources continues to be available so that clinicians and patients may retain this choice of treatment.

Animals↗

PubMed2001

Vertebral infections caused by Haemophilus aphrophilus: case report and review.

OBJECTIVE: To review in detail clinical presentation, bacteriologic findings, associated conditions and treatment of Haemophilus aphrophilus vertebral osteomyelitis and to compare them to a case we report herein. METHODS: A Medline (National Library of Medicine) search of the literature was performed by using the key words H. aphrophilus, spondylodiscitis, discitis, and vertebral osteomyelitis. The references of the case reports were examined for additional cases, especially those cited in older articles that had not been entered onto the bibliographic database. RESULTS: A case report of spondylodiscitis due to H. aphrophilus in a 35-year-old patient with a history of dental abscess 7 months before admission is presented. The patient responded well to treatment with ceftriaxone and ciprofloxacin. To date, only 14 cases of H. aphrophilus vertebral osteomyelitis have been reported. They are usually reported in middle-aged patients, usually male. Most recent cases have been treated with fluoroquinolones. Duration of treatment usually ranges from 1 to 3 months. CONCLUSIONS: H. aphrophilus is an uncommon cause of vertebral osteomyelitis. Patients are regularly cured by antibiotic therapy, provided that a tissue biopsy is performed in order to isolate the causative bacterium.

Adult↗

PubMed2002

A first class knowledge service: developing the National electronic Library for Health.

With the introduction of clinical governance and the move towards evidence-based practice, there is a growing need to provide health professionals and patients, and the public, with high quality information. Developments in the health service have added weight and urgency to this need. The National electronic Library for Health (NeLH) has a key role to play in providing health professionals with a core knowledge base of accredited and evaluated information. The Pilot NeLH was launched in November and this article outlines the progress and achievements made during this time. The NeLH is based around a central website featuring core resources and links to commissioned specialist collections. Over 70 information resources, including bibliographic databases and full text publications, are accessible via the NeLH, which aims to act as a one-stop shop to support evidence-based decision-making. Much work has been undertaken on national procurement and licensing, particularly in partnership with National Health Service (NHS) libraries. Partnerships as a whole are crucial to ensure true seamless access for health professionals. Key partners include NHS libraries, NHS Direct Online and the electronic Library for Social Care. A short glossary is included for those readers less familiar with current health service developments in the UK.

Cooperative Behavior↗

PubMed2002

Motor recovery after stroke: a systematic review of the literature.

OBJECTIVE: To collect and integrate existing data concerning the occurrence, extent, time course, and prognostic determinants of motor recovery after stroke using a systematic methodologic approach. DATA SOURCES: A computer-aided search in bibliographic databases was done of longitudinal cohort studies, original prognostic studies, and randomized controlled trials published in the period 1966 to November 2001, which was expanded by references from retrieved articles and narrative reviews. STUDY SELECTION: After a preliminary screening, internal, external, and statistical validity was assessed by a priori methodologic criteria, with special emphasis on the internal validity. DATA EXTRACTION: The studies finally selected were discussed, based on the quantitative analysis of the outcome measures and prognostic determinants. Meta-analysis was pursued, but was not possible because of substantial heterogeneity. DATA SYNTHESIS: The search resulted in 174 potentially relevant studies, of which 80 passed the preliminary screening and were subjected to further methodologic assessment; 14 studies were finally selected. Approximately 65% of the hospitalized stroke survivors with initial motor deficits of the lower extremity showed some degree of motor recovery. In the case of paralysis, complete motor recovery occurred in less than 15% of the patients, both for the upper and lower extremities. Hospitalized patients with small lacunar strokes showed relatively good motor recovery. The recovery period in patients with severe stroke was twice as long as in patients with mild stroke. The initial grade of paresis was the most important predictor for motor recovery (odds ratios [OR], >4). Objective analysis of the motor pathways by motor-evoked potentials (MEPs) showed even higher ORs (ORs, >20). CONCLUSIONS: Our knowledge of motor recovery after stroke in more accurate, quantitative, and qualitive terms is still limited. Nevertheless, our data synthesis and quantitative analysis comprises data from many methodologically robust studies, which may support the clinician in the management of stroke patients. With respect to early prognosis of motor recovery, our review confirms clinical experience that the initial grade of paresis (as measured on admission in the hospital) is the most important predictor, although the accuracy of prediction rapidly improves during the first few days after stroke. Initial paralysis implies the worst prognosis for subsequent motor recovery. Remarkably, the prognostic accuracy of MEPs appears much higher than that of clinical examination for different subgroups of patients.

Activities of Daily Living↗

PubMed2000

Is there a positive volume-outcome relationship in peripheral vascular surgery? Results of a systematic review.

OBJECTIVES: to examine the evidence for the existence, or otherwise, of a positive volume-outcome relationship in the area of peripheral vascular surgery. DESIGN: systematic overview of prospective or retrospective volume-outcome studies. DATA SOURCES: seven bibliographic databases were searched for English-language articles published between 1986 and 1998. STUDY SELECTION: thirty-six articles published in peer-reviewed journals; excluding editorials, letters or abstracts; and addressing volume and outcome in peripheral vascular surgery. Criteria were applied and agreed by consensus between two of the authors. DATA EXTRACTION: the articles identified were independently assessed by two of the authors. Studies were categorised into three distinct areas - carotid endarterectomy- (17 studies), abdominal aortic aneurysm repair (16 studies) and other vascular interventions (four studies). Within each category studies were further classified according to full adjustment, partial adjustment or no adjustment for case mix. Where discrepancies arose, decisions were referred to a third author for arbitration. DATA SYNTHESIS: findings for carotid endarterectomy identified a positive volume-outcome relationship for both mortality and stroke at the physician level. There was less support for a positive relationship for mortality at the hospital level, and no evidence of benefits for stroke in higher volume hospitals. If only studies making a full adjustment for case mix are included, there is no clear support from statistically significant evidence for or against a positive volume-outcome relationship. For repair of unruptured abdominal aortic aneurysms there is evidence of a positive volume-outcome relationship at both the physician and hospital level, with evidence being particularly strong at the level of the hospital. For ruptured aneurysms the evidence is suggestive of there not being a positive volume-outcome relationship at the hospital level, while for physicians the evidence is more balanced with no clear support either way. For other vascular interventions there were insufficient studies (n=4) from which to draw meaningful conclusions. CONCLUSIONS: our results show that evidence of a relationship between volume and outcome in peripheral vascular surgery may be attributable to factors such as lack of adjustment for case-mix, different definitions of volume and poor quality of studies, especially those of retrospective design. Future studies should address these deficiencies by making full adjustment for case mix and by being prospective in design.

Aortic Aneurysm, Abdominal↗

PubMed2005

Causes of reversible nephrogenic diabetes insipidus: a systematic review.

BACKGROUND: In nephrogenic diabetes insipidus (NDI), the kidney is unable to produce concentrated urine because of the insensitivity of the distal nephron to antidiuretic hormone (arginine vasopressin). In settings in which fluid intake cannot be maintained, this may result in severe dehydration and electrolyte imbalances. The risk for conversion of reversible to irreversible NDI seems to be a potential complication. This review summarizes the reversible causes of acquired NDI to facilitate earlier recognition and more effective treatment by clinicians. METHODS: Two reviewers independently searched MEDLINE, Experta Medica (EMBASE), and ISI bibliographic databases. Human studies that described NDI caused by drugs, substances, or metabolic disturbances were included. To evaluate the causal role of the risk factor, data were abstracted according to Koch's postulates. RESULTS: One hundred fifty-five studies published between 1957 and March 2004 described 30 risk factors. Of 155 studies, 58 studies provided a "definite" diagnosis of NDI; 83 studies, a "probable" diagnosis; and 14 studies, a "possible" diagnosis. Nine factors were considered "definite" causes of NDI; 15 factors, "probable" causes; and 6 factors, "possible" causes. The most reported risk factors were lithium (84 studies), antibiotics (16 studies), antifungals (11 studies), antineoplastic agents (9 studies), antivirals (8 studies), and metabolic disturbances (8 studies). Duration of NDI reversal, as well as conversion to irreversible symptoms, seemed to depend on the duration of exposure. CONCLUSION: Most risk factors for reversible NDI were medications, and their identification and removal resulted in resolution of the condition. Long-term treatment with lithium seemed to result in irreversible NDI.

Anti-Infective Agents↗

PubMed2002

Child-rearing practices of primary caregivers of HIV-infected children: An integrative review of the literature.

The number of human immunodeficiency virus (HIV)-infected children has increased because of the HIV and acquired immunodeficiency syndrome epidemic. Yet little is known about the child-rearing practices of these children's primary caregivers. The purpose of this article is to describe what is known about the child-rearing practices of primary caregivers of HIV-infected children. The review covers a 10-year period from 1990 to 2000. Three electronic bibliographic databases (MEDLINE, CINAHL, and AIDSLINE) were explored. Key words used were HIV-positive children, caregivers, and child-rearing. A total of 50 papers were examined. Using the Matrix Method, each paper was evaluated according to five frames of reference: journal, purpose, sample, method, and findings. Content analysis was used to identity salient themes. Themes that emerged were: caregiver, child, and interactions or child-rearing practices. These findings affirm the parent-child interaction model generated by Kathryn E. Barnard and support this framework as a tool for investigating the relationships between these children and their caregivers.

Adaptation, Psychological↗

PubMed2001

A meta-analysis of alcohol drinking and cancer risk.

To evaluate the strength of the evidence provided by the epidemiological literature on the association between alcohol consumption and the risk of 18 neoplasms, we performed a search of the epidemiological literature from 1966 to 2000 using several bibliographic databases. Meta-regression models were fitted considering linear and non-linear effects of alcohol intake. The effects of characteristics of the studies, of selected covariates (tobacco) and of the gender of individuals included in the studies, were also investigated as putative sources of heterogeneity of the estimates. A total of 235 studies including over 117 000 cases were considered. Strong trends in risk were observed for cancers of the oral cavity and pharynx, oesophagus and larynx. Less strong direct relations were observed for cancers of the stomach, colon and rectum, liver, breast and ovary. For all these diseases, significant increased risks were found also for ethanol intake of 25 g per day. No significant nor consistent relation was observed for cancers of the pancreas, lung, prostate or bladder. Allowance for tobacco appreciably modified the relations with laryngeal, lung and bladder cancers, but not those with oral, oesophageal or colorectal cancers. This meta-analysis showed no evidence of a threshold effect for most alcohol-related neoplasms. The inference is limited by absence of distinction between lifelong abstainers and former drinkers in several studies, and the possible selective inclusion of relevant sites only in cohort studies.

Alcohol Drinking↗

PubMed2000

The prevalence of complementary and alternative medicine use among the general population: a systematic review of the literature.

OBJECTIVE: To conduct a systematic review of published research investigating the prevalence of complementary and alternative medicine (CAM) use in the general population. DESIGN: A protocol was developed for a systematic review of survey literature identified using two bibliographic databases and citation tracking. The protocol specified criteria for: 1) database searches; 2) selection of studies for review; and 3) description of methodological and substantive aspects of the studies. RESULTS: Twelve studies were reviewed. These estimated the prevalence of CAM use in Australia, Canada, Finland, Israel, the UK, and the USA. The most rigorous studies, conducted in Australia and the USA, showed that a high proportion of the population was using CAM. There was evidence from the USA that CAM use increased significantly among the general population during the 1990s. CONCLUSION: CAM is used by substantial proportions of the general population of a number of countries, but differences in study design and methodological limitations make it difficult to compare prevalence estimates both within and between countries.

Australia↗

PubMed1996

Diagnostic tests for temporomandibular disorders: an assessment of the methodologic quality of research reviews.

SUMMARY. The objective of this study was to assess review articles of temporomandibular disorder (TMD) diagnostic tests for methodological quality and to establish the need for a systematic reviewing process. Computerized bibliographic database searches from 1983 to December 1996, information requests from authors, and review of reference lists of all retrieved reports were used to identify relevant reviews. After applying selection criteria, two investigators independently reviewed the articles. Each review article was evaluated independently for methodological quality. Agreement between reviewers was measured using quadratic weighted kappa.Forty-five of 53 review articles met the selection criteria. No review described the search methods, selection criteria, demonstrably avoided selection bias or pooled data of primary studies. Three of 45 articles assessed the internal validity and reliability of the studies included in their review. Major to extensive methodological flaws were noted across all reviews.This critique of methodologic quality in TMD diagnostic review articles supports the need for a systematic reviewing process. Clinicians turning to diagnostic reviews to aid them in synthesizing a large body of literature may wish to apply the described methodologic criteria to separate 'valid' from 'invalid' reviews. Copyright 1996 Harcourt Publishers Ltd.

Journal Article↗