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PubMed2003

Teaching students how to read and write science: a mandatory course on scientific research and communication in medicine.

The authors describe the development and introduction of a course on scientific methodology and communication into the medical curriculum in a country outside of the mainstream scientific world. As editors of a general medical journal in Croatia, they learned that their colleagues had important and interesting data but no skills for presenting them in a scientific article. To alleviate the lack of education in research methodology and writing, the authors developed and introduced a mandatory course in scientific methodology and communication into the medical curriculum of the largest Croatian medical school. The course is structured into lectures, medium-sized-group discussions, and problem-solving small-group work, and is focused on (1) principles of scientific research; (2) access to medical literature and bibliographic databases; (3) study design and analysis and presentation of data; (4) assessing and writing a scientific article; and (5) responsible conduct of research. The course has been running since 1995-96 and is already showing results, visible in the more positive attitude of students toward scientific research and evidence-based medicine, and a significant number of students working on research projects and publishing scientific papers. The authors and colleagues also run continuing education courses for young academic physicians and an annual advanced workshop on scientific writing, involving academic physicians from all of southeastern Europe. The long-term goal is to create a critical mass of academic physicians with critical appraisal skills needed for evidence-based medicine and with skills for effectively communicating their research to the international scientific community.

Biomedical Research↗

PubMedDate not supplied

Lisuride, a dopamine receptor agonist with 5-HT2B receptor antagonist properties: absence of cardiac valvulopathy adverse drug reaction reports supports the concept of a crucial role for 5-HT2B receptor agonism in cardiac valvular fibrosis.

OBJECTIVES: The high incidence of fibrotic cardiac valvulopathies reported in association with the 8beta-ergoline dopamine (DA) agonist, pergolide, and also case reports for cabergoline and bromocriptine have made it necessary to review the theoretical basis and actual findings in the case of another DA agonist, the 8alpha-ergoline lisuride (used since the 1970s for migraine prophylaxis as well as since the 1980s for its prolactin-lowering and anti-Parkinson activity). METHODS: We have reviewed the pharmacology of lisuride in relation to other DA agonists, and we have performed a throughout literature search as well as a search of our own and other adverse drug reaction databases for a possible relationship of lisuride with cardiac valvulopathy or for any reports of fibrosis in other locations. RESULTS: Our review of the pharmacology and the literature strongly suggests that drug-induced cardiac valvulopathies are always related to a stimulatory drug effect on trophic 5-HT(2B) receptors. As lisuride is devoid of such an effect, but on the contrary is an extremely potent 5-HT(2B) antagonist, an association of lisuride therapy with cardiac valvulopathies seems to be highly unlikely. In agreement with this hypothesis, not a single report of a cardiac valvulopathy associated with lisuride therapy has been identified in any database so far.Furthermore, against a background of an estimated 360,000 patient years, we have found only a very small number of cases of any other form of fibrosis (1x retroperitoneal, 2x pleural, 2x pulmonary, 1x interstitial pulmonary changes), in part combined with other risk factors and confounding variables. This closely matches 4 reports available from WHO (1x retroperitoneal, 3x pleural fibrosis). In addition, only 5 other possibly related conditions (3x pleural effusion, 1x pleuritis, 1x pericarditis) were identified in the lisuride adverse drug reaction database of Schering, Berlin. CONCLUSIONS: No link has been found between lisuride use and fibrotic cardiac valvulopathy, in agreement with the 5-HT(2B) receptor antagonist effect of this drug. The very low incidence of spontaneous reports of any other fibrosis could be even compatible with an association by chance in the population exposed to lisuride. Although close monitoring for this kind of side effects is still to be recommended in the therapy with lisuride, our data do not support the concept of a class effect suggesting that all ergot-derived drugs and especially DA receptor agonists with some chemical similarity to the ergot structure will cause or facilitate cardiac valvulopathies as observed with pergolide.

Adverse Drug Reaction Reporting Systems↗

PubMed1996

How to keep up with the critical care literature and avoid being buried alive.

OBJECTIVE: To provide practical suggestions for accessing, utilizing, and storing the rapidly expanding literature on critical care. DATA SOURCES: Original research on information sources for clinicians and techniques for keeping up with the literature, found through bibliographic searches, our personal files, and consultation with critical care colleagues. DATA SYNTHESIS: Suggestions for keeping up with the critical care literature include: 1) focus the clinical question; 2) locate literature using bibliographic databases; 3) use original journal articles; 4) use systematic reviews with confidence; 5) use text-books with caution; 6) read the preappraised literature; 7) abandon advertisements; 8) throw away the throwaways; 9) teach yourself critical appraisal; 10) be wary of overinterpretation of substitute end points; 11) teach yourself basic clinical statistics; 12) engage in effective browsing; 13) store useful articles; 14) invest in informatics; and 15) implement evidence-based practice guidelines. CONCLUSION: Efficient access, appraisal, and application of the literature on intensive care are basic skills for intensivists, who have adopted a variety of resourceful and pragmatic methods for "keeping up."

Critical Care↗

PubMed2001

Bone anchor infections in female pelvic reconstructive procedures: a literature review of series and case reports.

PURPOSE: We determined the reported prevalence of infectious osseous complications due to the use of bone anchors for suture fixation in female pelvic reconstructive procedures. In addition, the type and method of bone anchors as well as the reported pathogens associated with osseous infections were reviewed. MATERIALS AND METHODS: Primary reported series of female pelvic reconstructive procedures involving bone anchor suture fixation referenced in Index Medicus from January 1990 to July 2000 were extracted using the MEDLINE bibliographic database on English language articles involving humans. All case reports of infectious osseous complications due to bone anchor use in female reconstructive procedures were also reviewed during this period. RESULTS: Since the inception of bone anchor suture fixation for female pelvic reconstructive procedures 10 years ago, the overall prevalence of related infectious complications has been 6 cases in 1,018 procedures (0.6%). This type of adverse event developed between followup weeks 1 and 24. The prevalence of suprapubic bone anchors has been 6 cases in 698 procedures (0.86%). For transvaginal bone anchor procedures no infectious cases have been reported in the combined series of 314 procedures and the same is true for 1 reported case of sacral bone anchor placement in 6 procedures. No statistical difference was noted in regard to the prevalence of infection in procedures involving suprapubic bone anchors and transvaginal bone anchor combined with sacral bone anchor placement (Fisher's exact test p = 0.19). The organisms reported in case reports suggest a coliform, skin or hematogenous source for contamination of the bone anchor site. CONCLUSIONS: An infectious bone anchor complication in female pelvic reconstructive procedures is an uncommon event with a reported prevalence of 0.6%. Currently there is no evidence of differences in the prevalence of osseous complications after transvaginal versus suprapubic bone anchor fixation. Preoperative broad-spectrum antibiotics are recommended to decrease the potential of infectious bone anchor complications.

Bone Diseases, Infectious↗

PubMedDate not supplied

Where is the evidence for teaching methods used in nursing education?

Twenty-first century maternal-child faculty members are now being encouraged to base their teaching practice on sound evidence. Finding that evidence, however, can be challenging. This article discusses not only the current state of research on teaching in nursing, but also how and where educators can access information about teaching that is based on research. It also describes strategies educators can use to develop an evidence-based approach to teaching. Topics included in this discussion include recommended literature resources in nursing and education, bibliographic database search techniques, guides for appraisal of quantitative and qualitative research, and relevant nursing education and general education professional organizations. In addition, an evidence hierarchy from the field of education is introduced to rank educational studies in nursing. If nurse educators are to apply the evidence-based process used in clinical practice to the practice of nursing education, more research is needed in this field.

Curriculum↗

PubMed1994

Neurosurgery online.

Explore the source record for details and available documents.

Databases, Bibliographic↗

PubMed1998

Ovulatory cycles, pregnancy outcome and complications after surgical treatment of polycystic ovary syndrome.

The purpose of this review is to survey the literature on the various laparoscopic surgical techniques for ovulation induction in polycystic ovary syndrome (PCOS) patients (multiple biopsies, electrocauterization, laser vaporization, ovarian resection), compared with traditional ovarian resection by laparotomy. Relevant studies were identified through a search of a computerized bibliographic database and cross-referencing of relevant medical journals. Data regarding 1803 anovulatory PCOS patients have been analyzed, 679 of them treated by classical ovarian resection after laparotomy, 720 by laparoscopic electrocauterization, 322 by laparoscopic laser vaporization, and 82 by laparoscopic multiple biopsies. The percentages of miscarriages, twin pregnancies, and ectopic pregnancies have been calculated analyzing 1076 pregnancies achieved spontaneously or after medical therapy after failure of various surgical attempts. The percentage of adhesions has been calculated among 343 patients submitted to second-look surgery. All of the surgical techniques proved equally effective, with an average ovulation rate of 78.8 percent, a cumulative pregnancy rate of 58.5 percent, a miscarriage rate of 15.9 percent, a twin pregnancy rate of 2.1 percent, and an ectopic pregnancy rate of 1.6 percent. Hormone variations after surgery consisted in a remarkable fall in serum androgen levels (androstenedione and testosterone), in an FSH increase, reduced biological activity and reduced amplitude of LH pulses, and an LH/FSH ratio trending toward normal levels. Moreover, after surgery, the ovaries showed higher responsiveness to drug-induced ovulation. Adhesions were less frequent after laparoscopic multiple biopsies, but they were observed in about 90 percent of patients after resection by laparotomy, in 30 percent of patients after laparoscopic electrocauterization, and in 50 percent after laparoscopic laser vaporization. In conclusion, at present laparoscopic methods for inducing ovulation can be performed in PCOS infertile patients if medical treatment fails to give the desired results. However, additional controlled trials are required to assess the long-term effects of these procedures.

Anovulation↗

PubMed1997

The epidemiology of low back pain in the rest of the world. A review of surveys in low- and middle-income countries.

STUDY DESIGN: A criteria-based review of the literature. SUMMARY OF BACKGROUND DATA: The literature on the epidemiology of low back pain is accumulating, but for the most part studies are restricted to high-income countries, which comprise less than 15% of the world's population. Little is known about the epidemiology of low back pain in the rest of the world. OBJECTIVES: To address the imbalance in the literature and to review the relatively few studies on the epidemiology of low back pain in low- and middle-income countries. Rates from these studies are contrasted with rates from selected high-income countries. In reviewing the literature, a hypothesis is tested: low back pain rates are higher in low-income countries than in high-income countries, not only because hard physical labor is more prevalent in low-income countries, but also because, unlike high-income countries, hard physical labor for older workers in low-income countries often is unavoidable. METHODS: Among other sources, articles for the review come from a search of the MEDLINE bibliographic database, with "back pain" and individual low- and middle-income countries entered as key words. To avoid recall biases, findings specifically on point prevalence are reviewed. RESULTS: Within the categories of low-income and high-income countries, low back pain rates vary twofold or more. In comparisons between these categories of countries, rates on the whole are higher among the general populations of selected high-income countries than among rural low-income populations; specifically, rates are 2-4 times higher among Swedish, German, and Belgium general populations than among Nigerian, southern Chinese, Indonesian, and Filipino farmers. Within low income countries, rates are higher among urban populations than among rural populations and still higher among workers in particular worksites, referred to as "enclosed workshops." CONCLUSIONS: The disparity in low back pain rates within categories of countries, high-income and low-income, calls attention to the high proportion of studies on the epidemiology of low back pain that are methodologically questionable. Recommendations are offered to improve the methodologic quality of this type of study. Conclusions may be drawn from comparisons between studies, although, in the absence of set methodologic standards, they are tentative. The considerably lower rates among populations of low-income farmers compared with rates of the affluent populations of selected northern European countries indicate that, contrary to the hypothesis proposed here, hard physical labor itself is not necessarily related to low back pain. The higher rates in urban low-income populations as compared with rates in rural low-income populations and the sharply higher rates among workers in enclosed workshops of low-income countries suggest a disturbing trend: low back pain prevalence may be on the rise among vast numbers of workers as urbanization and rapid industrialization proceed.

Adolescent↗

PubMed1999

Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation.

STUDY DESIGN: Potential precipitating events and risk factors for vertebrobasilar artery dissection were reviewed in an analysis of the English language literature published before 1993. OBJECTIVES: To assess the literature pertaining to precipitating neck movements and risk factors for vertebrobasilar artery dissection in an attempt to determine whether the incidence of these complications can be minimized. SUMMARY OF BACKGROUND DATA: Vertebrobasilar artery dissection and occlusion leading to brain stem and cerebellar ischemia and infarction are rare but often devastating complications of cervical, manipulation and neck trauma. Although various investigators have suggested potential risk factors and precipitating events, the basis for these suggestions remains unclear. METHODS: A detailed search of the literature using three computerized bibliographic databases was performed to identify English language articles from 1966 to 1993. Literature before 1966 was identified through a hand search of Index Medicus. References of articles obtained by database search were reviewed to identify additional relevant articles. Data presented in all articles meeting the inclusion criteria were summarized. RESULTS: The 367 case reports included in this study describe 160 cases of spontaneous onset, 115 cases of onset after spinal manipulation, 58 cases associated with trivial trauma, and 37 cases caused by major trauma (3 cases were classified in two categories). The nature of the precipitating trauma, neck movement, or type of manipulation that was performed was poorly defined in the literature, and it was not possible to identify a specific neck movement or trauma that would be considered the offending activity in the majority of cases. There were 208 (57%) men and 158 (43%) women (gender data not reported in one case) with an average age of 39.3 +/- 12.9 years. There was an overall prevalence of 13.4% hypertension, 6.5% migraines, 18% use of oral contraception (percent of female patients), and 4.9% smoking. In only isolated cases was specific vascular disease such as fibromuscular hyperplasia noted. CONCLUSIONS: The literature does not assist in the identification of the offending mechanical trauma, neck movement, or type of manipulation precipitating vertebrobasilar artery dissection or the identification of the patient at risk. Thus, given the current status of the literature, it is impossible to advise patients or physicians about how to avoid vertebrobasilar artery dissection when considering cervical manipulation or about specific sports or exercises that result in neck movement or trauma.

Aortic Dissection↗

PubMed2001

Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. SUMMARY OF BACKGROUND DATA: Multidisciplinary biopsychosocial rehabilitation programs for neck and shoulder pain require substantial staff and financial resources. They are widely used, despite questionable evidence of their effectiveness. METHODS: The reviewed randomized controlled and controlled trials appraising the effectiveness of biopsychosocial rehabilitation for working age patients with neck and shoulder pain were identified by searching electronic bibliographic databases, checking references, and consulting experts in the rehabilitation field. Four blinded reviewers selected the trials. Two specialists on rehabilitation evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results and the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level of scientific evidence. RESULTS: After 1808 abstracts and the references of 65 reviews were screened, only two relevant studies were found that satisfied the criteria. One of these was considered a methodologically low-quality randomized controlled trial, and the other was a methodologically low-quality controlled clinical trial. The clinical relevance of included studies was satisfactory. The level of scientific evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain was limited. CONCLUSIONS: There appears to be little scientific evidence for the effectiveness on neck and shoulder pain of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation methods. There is an urgent need for high-quality trials in this field.

Adult↗

PubMed2001

Multidisciplinary biopsychosocial rehabilitation for subacute low back pain in working-age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials was performed. OBJECTIVE: To evaluate the effectiveness of multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working-age adults. SUMMARY OF BACKGROUND DATA: Multidisciplinary biopsychosocial rehabilitation programs are widely applied for patients with chronic low back pain. The multidisciplinary biopsychosocial approach for prolonged low back pain could be considered to prevent chronicity. Work site visits and a close relationship with occupational health care might produce results in terms of patients working ability. METHODS: Reviewed randomized controlled trials as well as controlled trials were identified from electronic bibliographic databases, reference checking, and consultation with experts in the rehabilitation field. Four blinded reviewers selected the trials. Two rehabilitation specialists evaluated the clinical relevance. Two other blinded reviewers extracted the data and assessed the main results along with the methodologic quality of the studies. A qualitative analysis was performed to evaluate the level evidence. RESULTS: Of 1808 references, only 2 relevant studies were included. Both were considered to be methodologically low-quality randomized controlled trials. The clinical relevance of the studies was sufficient. The level of scientific evidence was moderate, showing that multidisciplinary rehabilitation involving work site visit or more comprehensive occupational health care intervention helps patients return to work faster, makes sick leaves less, and alleviates subjective disability. CONCLUSIONS: There is moderate evidence showing that multidisciplinary rehabilitation for subacute low back pain is effective, and that work site visit increases the effectiveness, but because the analyzed studies had some methodologic shortcomings, an obvious need still exists for high-quality trials in this field.

Humans↗

PubMed2002

A systematic review of the passive straight leg raising test as a diagnostic aid for low back pain (1989 to 2000).

STUDY DESIGN: A systematic review. OBJECTIVES: This systematic review sought papers (January 1989-January 2000) on the passive straight leg raising test (PSLR) as a diagnostic component for low back pain (LBP) to identify, summarize, and assess developments in the test procedure, the factors influencing PSLR outcome, and the clinical significance of that outcome. SUMMARY OF BACKGROUND DATA: Previous studies suggested that the PSLR tractioned the sciatic nerve and that diminished leg elevation with reproduced pain indicated low lumbar intervertebral disc pathology. METHODS: Searches on six computerized bibliographic databases identified publications written about the PSLR. Papers were excluded if they were published before January 1989, were non-English language papers, or employed either an active SLR or a PSLR for purposes other than LBP diagnosis. The references of qualifying papers (and the references of references) were searched. Contact with primary authors, and others known to be active in this field, was attempted. RESULTS: The PSLR procedure remains unchanged. The influence of hip rotation during the PSLR was discussed without consensus. Biomechanical devices improved intra- and interobserver reliability and so increased test reproducibility. Hamstrings were found to have a defensive role in protecting nerve roots by limiting PSLR range in cases of nerve root inflammation. A small diurnal variation in the PSLR may imply a poorer prognosis. A positive PSLR at 4 months after lumbar intervertebral disc surgery predicted poor reoperative outcome, and a negative 4-month PSLR predicted excellent outcome. The influence of psychosocial factors was not discussed, neither was the diagnostic significance of a negative PSLR outcome. CONCLUSIONS: There remains no standard PSLR procedure, no consensus on interpretation of results, and little recognition that a negative PSLR test outcome may be of greater diagnostic value than a positive one. The causal link between LBP pathology and hamstring action remains unclear. There is a need for research into the clinical use of the PSLR; its intra- and interobserver reliability; the influences of age, gender, diurnal variation, and psychosocial factors; and its predictive value in lumbar intervertebral disc surgery.

Age Factors↗

PubMed2005

The pH dependency of the binding of drugs to plasma proteins in man.

An analysis of pH-induced changes of drug binding may contribute to the understanding of the mechanisms involved and the clinical relevance. A literature search was performed, and acceptance criteria set up, to select reported data for quantitative evaluation. The relationship between percentage of unbound drug, fu, and pH was analyzed, and the relevance of physicochemical characteristics of the ligand drugs and the importance of hydrogen ion-induced changes in plasma proteins for the pH sensitivity of the binding were evaluated. With all basic and the majority of acidic drugs, fu depended linearly on pH. Basic drugs showed a consistent behavior with fu decreasing with increasing pH. Acidic compounds behaved differently: With some, fu increased, and with others fu decreased, with pH, and with a third group of acids fu was pH independent. Large differences in the pH sensitivity of the plasma protein binding among individual compounds were found. The fu in plasma for some bases and acids increased up to 136% and 95%, respectively, at pH values seen in severe acidemia or alkemia. These changes in fu could be clinically relevant with narrow-therapeutic-range drugs. Physicochemical properties and other characteristics of the ligands affect the pH sensitivity of the interaction with plasma proteins, but there was clear evidence indicating that pH-induced changes in the plasma proteins are also involved in the observed pH-dependent interaction with ligands. It is generally accepted that the unbound, free fraction in whole blood or plasma is an important determinant of the pharmacokinetics and pharmacodynamics of drugs. pH-dependent protein binding and consequent changes in the free fraction have been reported for many drugs. From a basic science point of view, the systematic study of pH-induced perturbations of the drug-protein interaction may provide insight into the mechanism and forces involved in the binding of drugs to plasma proteins. From a clinical viewpoint it may be of interest to know the extent of pH-induced changes in the unbound fraction of drugs under extreme acidemic or alkalemic conditions. Arterial blood pH values compatible with life reportedly range between 6.7 and 8.0. pH values as low as 6.3 have been measured in survivors of drowning accidents. To the best knowledge of the authors, a review and interpretation of pH-associated changes in the protein binding of drugs has not been attempted to date. The goals of this investigation were to (1) review published results of studies that determined the impact of pH changes on the protein binding of drugs in man, (2) select representative data using predetermined criteria, (3) determine relevant factors impacting the pH sensitivity of the drug-protein interaction, and (4) attempt to interpret the results and their clinical relevance.

Acidosis↗

PubMed2002

Psychiatric genetics in silico: databases and tools for psychiatric geneticists.

Bioinformatics can significantly impact the laboratory genetics process from the study design phase to conclusive identification of a disease gene. The present review will highlight key databases to enhance psychiatric genetic study design, based on full use of genomics data and the golden path sequence. It will address methods to ensure comprehensive genetic data mining, using the best available genomic and genetic databases such as the University of California Santa Cruz human genome browser, Ensembl, Mapview, dbSNP and GDB, and locus-specific databases such as Online Mendelian Inheritance In Man. Using the golden path sequence as a template, with the necessary quality checks, it is possible to design detailed genetic studies from sequence information alone. Drawing together this diverse information, it is possible to characterize a locus or gene in silico to a very detailed level. This in turn can have real cost and efficiency benefits by assisting in the identification of markers that are most likely to be informative, or by highlighting the best candidate genes for study.

Databases, Bibliographic↗

PubMed2001

A systematic review of physical interventions for patellofemoral pain syndrome.

OBJECTIVE: Physical interventions (nonpharmacological and nonsurgical) are the mainstay of treatment for patellofemoral pain syndrome (PFPS). Physiotherapy is the most common of all physical interventions and includes specific vastus medialis obliquus or general quadriceps strengthening and/or realignment procedures (tape, brace, stretching). These treatments appear to be based on sound theoretical rationale and have attained widespread acceptance, but evidence for the efficacy of these interventions is not well established. This review will present the available evidence for physical interventions for PFPS. DATA SOURCES: Computerized bibliographic databases (MEDLINE, Current Contents, CINAHL) were searched, including the keywords "patellofemoral," "patella," and "anterior knee pain," combined with "treatment," "rehabilitation," and limited to clinical trials through October 2000. STUDY SELECTION: The critical eligibility criteria used for inclusion were that the study be a controlled trial, that outcome assessments were adequately described, and that the treatment was a nonpharmacological, nonsurgical physical intervention. RESULTS: Of the 89 potentially relevant titles, 16 studies were reviewed and none of these fulfilled all of the requirements for a randomized, controlled trial. Physiotherapy interventions were evaluated in eight trials, and the remaining eight trials examined different physical interventions. Significant reductions in PFPS symptoms were found with a corrective foot orthosis and a progressive resistance brace, but there is no evidence to support the use of patellofemoral orthoses, acupuncture, low-level laser, chiropractic patellar mobilization, or patellar taping. Overall the physiotherapy interventions had significant beneficial effects but these interventions were not compared with a placebo control. There is inconclusive evidence to support the superiority of one physiotherapy intervention compared with others. CONCLUSIONS: The evidence to support the use of physical interventions in the management of PFPS is limited. There appears to be a consistent improvement in short-term pain and function due to physiotherapy treatment, but comparison with a placebo group is required to determine efficacy, and further trials are warranted for the other interventions.

Adolescent↗

PubMed2004

Accuracy of urinalysis dipstick techniques in predicting significant proteinuria in pregnancy.

OBJECTIVE: To estimate the accuracy of point-of-care dipstick urinalysis in predicting significant proteinuria in pregnancy. DATA SOURCES: Literature from 1970 to February 2002 was identified via 1). general bibliographic databases, that is, MEDLINE and EMBASE, 2). Cochrane Library and relevant specialist register of the Cochrane Collaboration, and 3). checking the reference lists of known primary and review articles. METHODS OF STUDY SELECTION: Studies were selected if the accuracy of dipstick urinalysis techniques in predicting total protein excretion was estimated compared with a reference standard (laboratory estimation of protein excretion). The tests included visually read color-change dipsticks and automated dipstick urinalysis. Study selection, quality assessment, and data abstraction were performed independently and in duplicate. TABULATION, INTEGRATION, AND RESULTS: Data from selected studies were abstracted as 2 x 2 tables comparing the test result with the reference standard. Test accuracy was expressed as likelihood ratios. Summary likelihood ratios were generated as measures of diagnostic accuracy to determine posttest probabilities. The electronic search produced 1543 citations. After independent review of published articles, a total of 34 articles was obtained for further scrutiny, and 7 studies were considered eligible for inclusion in the review. The 6 studies evaluating visual dipstick urinalysis produced a pooled positive likelihood ratio of 3.48 (95% confidence interval 1.66, 7.27) and a pooled negative likelihood ratio of 0.6 (95% confidence interval 0.45, 0.8) for predicting 300 mg/24-hour proteinuria at the 1+ or greater threshold. CONCLUSION: The accuracy of dipstick urinalysis with a 1+ threshold in the prediction of significant proteinuria is poor and therefore of limited usefulness to the clinician. Accuracy may be improved at higher thresholds (greater than 1+ proteinuria), but available data are sparse and of poor methodological quality. Therefore, it is not possible to make meaningful inferences about accuracy at higher urine dipstick thresholds. There is an urgent need for research in this area of common obstetric practice.

Female↗

PubMed2004

A Cochrane review of manipulation and mobilization for mechanical neck disorders.

STUDY DESIGN AND OBJECTIVES: Our systematic review of randomized trials assessed whether manipulation and mobilization relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders. SUMMARY OF BACKGROUND DATA: Neck disorders are common, disabling, and costly. METHODS: Computerized bibliographic databases were searched up to March 2002. Two independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. Relative risk and standardized mean differences were calculated. In the absence of heterogeneity, pooled effect measures were calculated using a random effects model. RESULTS: Of the 33 selected trials, 42% were high quality trials. Single or multiple (3-11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache. There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for pain reduction [pooled standardized mean differences -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [standardized mean differences -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic mechanical neck disorders with or without headache. CONCLUSIONS: Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix.

Adult↗

PubMed2006

Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group.

STUDY DESIGN: Systematic review. OBJECTIVES: To review the various radiographic parameters currently used to assess traumatic thoracolumbar injuries, emphasizing the validity and technique behind each one, to formulate evidence-based guidelines for a standardized radiographic method of assessment of these fractures. SUMMARY OF BACKGROUND DATA: The treatment of thoracolumbar fractures is guided by various radiographic measurement parameters. Unfortunately, for each group of parameters, there has usually been more than 1 proposed measurement technique, thus creating confusion when gathering data and reporting outcomes. Ultimately, this effect results in clinical decisions being based on nonstandardized, nonvalidated outcome measures. METHODS: Computerized bibliographic databases were searched up to January 2004 using key words and Medical Subject Headings on thoracolumbar spine trauma, radiographic parameters, and methodologic terms. Using strict inclusion criteria, 2 independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. RESULTS: There were 18 original articles that ultimately constituted the basis for the review. Of radiographic measurement parameters, 3 major groups were identified, depicting the properties of the injured spinal column: sagittal alignment, vertebral body compression, and spinal canal dimensions, with 14 radiographic parameters reported to assess these properties. CONCLUSIONS: Based on a systematic review of the literature and expert opinion from an experienced group of spine trauma surgeons, it is recommended that the following radiographic parameters should be used routinely to assess thoracolumbar fractures: the Cobb angle, to assess sagittal alignment; vertebral body translation percentage, to express traumatic anterolisthesis; anterior vertebral body compression percentage, to assess vertebral body compression, the sagittal-to-transverse canal diameter ratio, and canal total cross-sectional area (measured or calculated); and the percent canal occlusion, to assess canal dimensions.

Consensus↗