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PubMedDate not supplied

Clinical diagnosis of carpal tunnel syndrome: a systematic review.

The purposes of this systematic review were to examine the properties of clinical tests used in the diagnosis of carpal tunnel syndrome (CTS) and to provide estimates of their sensitivity and specificity. A literature search was conducted using two databases-PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)-from 1986 to June 2003, and hand-searching reference lists of retrieved articles. Two reviewers evaluated the papers for quality using an evaluation tool developed by one of the authors. Estimates of sensitivity and specificity were determined by averaging values across studies weighted by sample size. Although 60 studies were reviewed in detail, many were of poor quality (mean quality score was 6.6 of 12, with only 15 of 60 obtaining a score of 8 or greater). The most frequently studied test was Phalen's, with an overall estimate of 68% sensitivity and 73% specificity. Next was Tinel's, with estimates of 50% and 77%, and then carpal compression, with estimates of 64% and 83% for sensitivity and specificity, respectively. Two-point discrimination and testing of atrophy or strength of the abductor pollicis brevis proved to be specific but not very sensitive. The estimates determined in this review should help therapists choose clinical tests with the appropriate balance of sensitivity and specificity required for diagnosing carpal tunnel syndrome in their specific clinical environments.

Carpal Tunnel Syndrome↗

PubMed1999

Systematic reviews and meta-analysis: a structured review of the methodological literature.

OBJECTIVE: To systematically review methods for systematic review/meta-analysis in order to identify the different methodological and statistical methods that have been proposed. A summary of the main findings is presented here, with emphasis given to health services research topics. METHODS: A thorough systematic search for methodological papers was carried out using a variety of methods, including the use of electronic databases. Approximately 1000 potentially relevant references were identified, a number of them from education, psychology and sociology. RESULTS: After briefly reviewing the procedural methods required to carry out a review, and the basic statistical methods used to combine study estimates, less established methods are discussed. These include methods for dealing with publication bias, meta-regression, meta-analysis of individual patient data, the synthesis of non-randomized evidence alone and in combination with randomized studies. Bayesian modelling and economic evaluation through meta-analysis. Recommendations for meta-analytical practice are given; these are either distilled from previous guidelines, or constructed where there appears to be a broad consensus across the literature. CONCLUSIONS: It is hoped that this review will provide a consistent and comprehensive, but concise, description of the methods available for synthesizing evidence, that it will promote better quality reviews of the results of health services research and identify specific areas which require methodological development.

Bayes Theorem↗

PubMed2005

Acupuncture analgesia during surgery: a systematic review.

The aim of this systematic review is to assess the effectiveness of acupuncture as an adjunctive analgesic method to standard anaesthetic procedures for surgery and to determine whether acupuncture has any analgesic-sparing effect. Electronic literature searches for randomised clinical trials (RCTs) of acupuncture during surgery were performed in seven electronic databases. No language restrictions were imposed. All included studies were rated according to their methodological quality and validity. As the studies were clinically heterogeneous, no meta-analyses were performed. The evidence was classified according to four levels: strong, moderate, limited, or inconclusive. Nineteen RCTs were identified. Seven of them suggested that acupuncture is efficacious. Of nine high-quality RCTs, two studies had positive outcomes. There was no significant association between study quality and direction of outcome. One of eight high-validity trials reported a positive outcome and there was a significant relationship between validity and direction of outcome. The evidence that acupuncture is more effective than no acupuncture as an adjunct to standard anaesthetic procedures is therefore inconclusive. Strong evidence exists that real acupuncture is not significantly different from placebo acupuncture. For an analgesic-sparing effect of acupuncture, evidence remains inconclusive. In conclusion, this review does not support the use of acupuncture as an adjunct to standard anaesthetic procedures during surgery.

Acupuncture Analgesia↗

PubMed2006

Clinical utility of office-based cognitive predictors of fitness to drive in persons with dementia: A systematic review.

OBJECTIVES: To perform a systematic review of evidence available regarding in-office cognitive tests that differentiate safe from unsafe drivers with dementia. DESIGN: A comprehensive literature search of multiple databases including Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. This was supplemented by a search of Current Contents and a review of the bibliographies of all relevant articles. SETTING: English prospective cohort, retrospective cohort, and case-control studies that used accepted diagnostic criteria for dementia or Alzheimer's disease and that employed one of the primary outcomes of crash, simulator assessment, or on-road assessment were included. PARTICIPANTS: Two reviewers. MEASUREMENTS: The reviewers independently assessed study design, main outcome of interest, cognitive tests, and population details and assigned a Newcastle-Ottawa quality assessment rating. RESULTS: Sixteen articles met the inclusion criteria. Tests recommended by guidelines (e.g., the American Medical Association (AMA) and Canadian Medical Association guidelines) for the assessment of fitness to drive did not demonstrate robustly positive findings (e.g., Mini-Mental State Examination, Trails B) or were not evaluated in any of the included studies (e.g., Clock Drawing). Fifteen studies did not report any cutoff scores. CONCLUSION: Without validated cutoff scores, it is impossible to employ tests in a standardized fashion in front-line clinical settings. This study identified a research gap that will prevent the development of evidence-based guidelines. Recommendations to address this gap are that driving researchers routinely perform cutoff score analyses and that stakeholder organizations (e.g., AMA, American Geriatrics Society) sponsor consensus fora to review driving research methodologies.

Accidents, Traffic↗

PubMed2006

Follow-up of posttraumatic ligamentous and meniscal knee lesions detected at MR imaging: systematic review.

PURPOSE: To perform a systematic review of the literature regarding the natural course of ligamentous and meniscal knee lesions detected at magnetic resonance (MR) imaging. MATERIALS AND METHODS: The MEDLINE database was searched from January 1966 to February 2003. Studies were included if all of the following criteria were met: patients had collateral ligament, cruciate ligament, or meniscal lesions; MR imaging was performed in all patients; study included a group and/or subgroup of patients who underwent conservative treatment during follow-up; patients returned to the clinic for follow-up and clinical data or MR imaging outcomes were noted; and article was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and kappa statistics were used to grade the level of agreement between the two reviewers. Studies with quality scores of 8 or more were designated as high quality. Results were compared with regard to study design and quality scores. RESULTS: The literature search identified 649 articles, and 11 studies (five on posterior cruciate ligament [PCL] injuries, five on anterior cruciate ligament [ACL] injuries, and one on meniscal injuries) met the inclusion criteria. No studies on the follow-up of collateral ligament injuries were identified. Four studies were of high quality, and the kappa value for quality items was 0.80. Between 77% and 93% of the partial or complete PCL ruptures regained continuity. In cases of partial or total ACL rupture, repair of continuity was also possible. A possible association between MR imaging continuity and clinical stability was identified. CONCLUSION: The ACL and PCL can regain continuity after partial or complete rupture. On the basis of this review, no conclusions can be drawn about the natural course of meniscal or collateral ligament injury seen at MR imaging.

Anterior Cruciate Ligament Injuries↗

PubMed2002

Perineal pad test in evaluating outcome of treatments for female incontinence: a systematic review.

Our objective was to systematically review clinical studies of incontinence treatments for women that used pad tests to assess outcome, to determine how closely the ICS guidelines had been followed. Our review (Medline 1988-2000, plus referenced studies) identified 75 relevant papers, carrying out pad tests in clinics ( n = 53) or patients' homes ( n = 28). Clinic pad tests lasted between 60 seconds and 2 hours, with inconsistent starting bladder volumes, activities carried out, other test details and presentation of results. Home pad tests lasted between 1.5 and 48 hours: the conduct and reporting of these tests were also variable. Only 25 studies used pad tests that were apparently consistent with ICS guidelines. Pad tests are important in identifying urine loss in clinical evaluations; however, we found wide variations in their conduct and reporting. We recommend that the ICS should review the guidelines, and that further research should develop clinically valid pad tests. Authors and journal editors should ensure that pad test details are fully reported.

Female↗

PubMedDate not supplied

Evidence of evidence-based health policy: the politics of systematic reviews in coverage decisions.

U.S. policymakers are making greater use of findings from systematic reviews, the principal product of the discipline of research synthesis. This paper summarizes the methodology and availability of systematic reviews and the brief history of their introduction to policymakers in the public and private sectors and health professionals in the United States. Then, as a case study, the paper describes how officials in a consortium of states are using systematic reviews to inform decisions about coverage for pharmaceuticals. Finally, it explores the prospects for wider use of systematic reviews by policymakers.

Decision Making↗

PubMed2005

Socioeconomic status as a risk factor for HIV infection in women in East, Central and Southern Africa: a systematic review.

This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner's SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.

Adult↗

PubMed2005

The prevalence of genital Chlamydia trachomatis in Australia 1997-2004: a systematic review.

OBJECTIVES: To determine by systematic review the prevalence of genital chlamydial infection in Australia between 1997 and 2004. METHODS: Electronic literature databases, reference lists, and conference proceedings were searched and health agencies and jurisdictions were contacted for published and unpublished reports. Studies were eligible if they offered a diagnostic nucleic acid amplification test to consecutive individuals presenting during the study period. As a summary measure of the available data, mean prevalence rates, weighted by sample size and irrespective of participant age, were calculated for the population sub-groups. RESULTS: 40 studies of 50 populations and 40,587 individuals met the inclusion criteria, but only one of these was population-based. The use of non-systematic methodologies prevented an assessment of time trends and a statistical comparison of population sub-groups. The mean overall prevalence of genital chlamydial infection was 4.6% (95% CI 4.4-4.8%), reflecting over-sampling of high-risk groups. The mean community-based rates were 7.5% (95% CI 6.4-8.6%) and 8.7% (95% CI 7.9-9.7%) for Indigenous men and women, and 1.5% (95% CI 1.1-1.9%) and 1.4% (95% CI 0.9-2.0%) for non-Indigenous men and women. The overall mean estimates for other groups were 3.3% (95% CI 3.0-3.7%) for female attendees of sexual health and related clinics, 5.6% (95% CI 4.9-6.4%) for adolescents and young adults, 3.3% (95% CI 2.8-3.9%) for sex workers, and 1.6% (95% CI 1.2-2.0%) for urethral infection in men who have sex with men. Clinic-based estimates were generally, although not consistently, higher than community-based estimates. There is no serial population-based data for sexually active young men and women, but the available age-specific rates suggest under-ascertainment by the routine surveillance systems. CONCLUSIONS: The prevalence of genital chlamydial infection in Indigenous Australians and young adults is unacceptably high and quality epidemiological studies are urgently required to supplement the routinely collected national notification data.

Adolescent↗

PubMed2001

Falls risk factors in the hospital setting: a systematic review.

The objective of this systematic review was to summarize the best available evidence on the factors that increase the risk of patients falling during hospitalization. Studies included in the review were those that involved adult patients in hospital, that attempted to identify risk factors for falling, and used a cohort or case-control research design. The search strategy covered all major databases and including MEDLINE, CINAHL, Current Contents, Psyclit, Embase and the Cochrane Library. Results were summarized by a narrative discussion, identifying risk factors that were commonly identified in a range of practice settings. Eighteen papers met the review inclusion criteria and are reported in this paper. Factors associated with an increased risk of falling include impaired mental status, special toileting needs, impaired mobility, and a history of falling. While findings are contradictory, it appears that both medications and advanced age will also influence a patient's risk of falling.

Accidental Falls↗

PubMed2006

A systematic review and meta-analysis of the relationship between lipoprotein lipase Asn291Ser variant and diseases.

This systematic review attempted to summarize the associations between the Asn291Ser variant in the lipoprotein lipase (LPL) gene and dyslipidemia, the risk of type 2 diabetes mellitus (T2DM), and coronary heart disease (CHD). In addition, the relationships between the Asn291Ser variant and other metabolic diseases such as obesity and high blood pressure were also investigated in this systematic review. We systematically reviewed the literature by means of a meta-analysis. Twenty-one articles, including 19,246 white subjects, were selected for this meta-analysis. The summary standardized mean difference (SMD) of plasma triglyceride (TG) for carriers compared with noncarriers of the Asn291Ser variant was 3.23 (P < 0.00001). The summary SMD of plasma HDL-cholsterol (HDL-C) for carriers compared with noncarriers of the Asn291Ser variant was -3.42 (P < 0.0001). The summary SMD of the association of the Asn291Ser variant with plasma TG increased with increasing age and weight gain. Significant interactions between the LPL Asn291Ser variant and fasting glucose, T2DM, and CHD were seen (P = 0.02, 0.04, and 0.01, respectively). No significant interactions were seen between the LPL Asn291Ser variant and body mass index, waist-hip ratio, and blood pressure (P > 0.05). This meta-analysis indicates that the Asn291Ser variant in the LPL gene is a risk factor for dyslipidemia, characterized by hypertriglyceridemia and low HDL-C levels. And the Asn291Ser variant in the LPL gene predisposes to more severe dyslipidemia with increasing age and weight gain. Also, this meta-analysis shows that the LPL Asn291Ser variant is associated with CHD and T2DM.

Amino Acid Substitution↗

PubMed2007

Management of septic arthritis: a systematic review.

OBJECTIVE: To evaluate the existing evidence on the diagnosis and management of septic arthritis in native joints. DESIGN: Systematic review. DATA SOURCES: Cochrane Library, Medline, Embase, National Electronic Library for Health, reference lists, national experts. REVIEW METHODS: Systematic review of the literature with evaluation of the methodological quality of the selected papers using defined criteria set out by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians. RESULTS: 3291 citations were initially identified. Of these, 189 full text articles were identified for potential selection. Following review of these full text articles, 80 articles were found to fulfil the inclusion criteria and were included in the final list. CONCLUSIONS: were drawn on the diagnosis, investigation and management of septic arthritis. DISCUSSION: Little good quality evidence exists to guide the diagnosis and management of septic arthritis. Overall, no investigation is more reliable in the diagnosis of septic arthritis than the opinion of an experienced doctor. Aspiration and culture of synovial fluid is crucial to the diagnosis, but measurement of cell count is unhelpful. Antibiotics are clearly required for a prolonged period, but there are no data to indicate by which route or for how long. Key unanswered questions remain surrounding the medical and surgical management of the infected joint.

Anti-Bacterial Agents↗

PubMed2000

Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized and double-blind controlled trials was performed. SUMMARY OF BACKGROUND DATA: Nonsteroidal anti-inflammatory drugs are the most frequently prescribed medications worldwide and are widely used for patients with low back pain. OBJECTIVES: To assess the effects of nonsteroidal anti-inflammatory drugs in the treatment of nonspecific low back pain with or without radiation, and to assess which type of nonsteroidal anti-inflammatory drug is most effective. METHODS: For this study, the Cochrane Controlled Trials Register, Medline and Embase, and reference lists of articles were searched. Two reviewers blinded with respect to authors, institution, and journal independently extracted data and assessed the methodologic quality of the studies. If data were considered clinically homogeneous, a meta-analysis was performed. If data were considered clinically heterogeneous, a qualitative analysis was performed using a rating system with four levels of evidence: strong, moderate, limited, and no evidence. RESULTS: This review involved 51 trials and 6057 patients. Of these trials, 16 (31%) were of high quality. The pooled relative risk for global improvement after 1 week was 1.24 (95% confidence interval [CI] = 1.10-1.41), and for additional analgesic use was 1.29 (95% CI = 1.05-1.57), indicating a statistically significant but small effect in favor of nonsteroidal anti-inflammatory drugs as compared with a placebo. The results of the qualitative analysis showed that there is conflicting evidence (Level 3) that nonsteroidal anti-inflammatory drugs are more effective than paracetamol for acute low back pain, and that there is moderate evidence (Level 2) that nonsteroidal anti-inflammatory drugs are not more effective than other drugs for acute low back pain. There is strong evidence (Level 1) that various types of nonsteroidal anti-inflammatory drugs are equally effective for acute low back pain. CONCLUSIONS: The evidence from the 51 trials included in this review suggests that nonsteroidal anti-inflammatory drugs are effective for short-term symptomatic relief in patients with acute low back pain. Furthermore, there does not seem to be a specific type of nonsteroidal anti-inflammatory drug that is clearly more effective than others. Sufficient evidence on chronic low back pain still is lacking.

Adolescent↗

PubMed2003

Effect of reminiscence therapy on depression in older adults: a systematic review.

The objective of this systematic review is to provide healthcare professionals with information to assist in their decision to utilize reminiscence therapy for depression reduction in older adults outside of the primary care setting. Nine reviewed studies that were randomized controlled trials not only varied in person, outcome measurement, control, and exposure/intervention, the results of these studies were also diverse. About half of these studies showed that reminiscence therapy resulted in statistical significantly decrease in depression. Despite that reminiscence therapy requires further testing, it should be considered as a valuable intervention. Future directions of studies on reminiscence therapy are suggested.

Aged↗

PubMed2002

Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review.

OBJECTIVE: To conduct a systematic review to determine the relative effectiveness of treatments currently employed in the management of superior vena caval obstruction (SVCO). SEARCH STRATEGY: Electronic searching of the Cochrane Clinical Trials Register, Medline and Embase with identification of further studies from references cited in trials identified by electronic searching. SELECTION CRITERIA: Both randomized and non-randomized controlled trials in which patients with carcinoma of the bronchus and SVCO had been treated with any combination of steroids, chemotherapy, radiotherapy or insertion of an expandable metal stent. DATA COLLECTION AND ANALYSIS: There were three randomized and 98 non-randomized studies of which two and 44 respectively met the inclusion criteria. MAIN RESULTS: Superior vena caval obstruction was present at diagnosis in 10.0% of patients with small cell lung cancer (SCLC) and 1.7% of patients with non-small cell lung cancer (NSCLC). In one small randomized trial in SCLC, the rate of SVCO relapse was not significantly reduced by giving radiotherapy on completion of chemotherapy. In another, in NSCLC, the addition of induction chemotherapy to a course of synchronous chemo-radiotherapy did not provide greater relief of SVCO. In SCLC chemotherapy and/or radiotherapy relieved SVCO in 77%; 17% of those treated had a recurrence of SVCO. In NSCLC, 60% had relief of SVCO following chemotherapy and/or radiotherapy; 19% of those treated had a recurrence of SVCO. Insertion of an SVC stent relieved SVCO in 95%; 11% of those treated had further SVCO but recanalization was possible in the majority resulting in a long-term patency rate of 92%. Morbidity following stent insertion was greater if thrombolytics were administered. REVIEWERS' CONCLUSIONS: Chemotherapy and radiotherapy are effective in relieving SVCO in a proportion of patients whilst stent insertion may provide relief in a higher proportion and more rapidly. The effectiveness of steroids and the optimal timing of stent insertion (whether at diagnosis or following failure of other modalities) remain uncertain.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Nonpharmacological strategies for improving heart failure outcomes in the community: a systematic review.

The purpose of this systematic review was to synthesize current evidence regarding nonpharmacological approaches to heart failure (HF) management. Following a literature search, identified studies were coded using the Heart Failure Study Assessment Scale (HFSAS) developed by the authors. Results included high-quality ratings, a predominance of multidisciplinary disease management studies, decreased readmission rates, and some improvement in quality of life. Implications for practice, leadership, education, and research are described.

Ambulatory Care↗

PubMed2005

How old is this fracture? Radiologic dating of fractures in children: a systematic review.

OBJECTIVE: We conducted a systematic review of the literature to define the evidence for radiologic dating of fractures in children in the context of child protection. CONCLUSION: Radiologic dating of fractures is an inexact science. Most radiologists date fractures on the basis of their personal clinical experience, and the literature provides little consistent data to act as a resource. There is an urgent need for research to validate the criteria used in the radiologic dating of fractures in children younger than 5 years.

Child↗

PubMed2002

Reservoirs of MRSA in the acute hospital setting: a systematic review.

The aim of this systematic review was to critically analyse the literature and present the best available evidence relating to the significance of environmental factors, including equipment, in the transmission of methicillin resistant Staphylococcus aureus (MRSA) to hospitalised patients. Despite an extensive literature search only twenty studies that met the inclusion criteria were identified and analysed. There is evidence that the equipment and the inanimate environment are common reservoirs of MRSA, and that the rate of nosocommial transmission of the organism is influenced by occupancy rate and the design of clinical settings.

Cross Infection↗