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PubMed2004

Population-based health indexes: a systematic review.

This paper presents a systematic review the literature pertaining to the development and use of population-based health indexes with regard to reason for development of the index, geographical level of aggregation, inclusion of health indicators, weighting, sources of data and validation. Any type of population-based health index that incorporated at least two health indicators was considered for inclusion in the review. Studies from the UK, Europe and North America were considered. Seventeen individual studies and one review describing a population-based health index are described. The health indexes were designed for a wide variety of purposes. Levels of geographical aggregation ranged from ward to national level. There was considerable variation between these studies regarding the indicators chosen for inclusion in the health indexes as well as the methods used to combine them. Fourteen of the 18 included studies reported information on weighting of the indicators. None of the studies gave justification for the method of weighting chosen. Indicators were on the whole obtained from routine data sources. Only four of the indexes addressed the problem of validity. A population-based health index is potentially a very useful tool for monitoring the health of a community. More research is needed to determine which health indicators should be used in the formation of such an index and the most appropriate method to combine them.

Adolescent↗

PubMed1991

Technetium-99m-RBC venography in the diagnosis of deep venous thrombosis of the lower extremity: a systematic review of the literature.

We systematically reviewed the six articles from the English-language medical literature, since 1979, which compared 99mTc-RBC venography with contrast venography for the diagnosis of deep venous thrombosis (DVT) of the lower extremity. The studies were generally small in size and poorly compliant with methodologic standards for diagnostic test research. There was considerable variation in both how the 99mTc-RBC venograms were performed and how they were interpreted. Sufficient clinical information on the patients was not provided. Although the overall sensitivities and specificities were high with a mean sensitivity of 0.89 and a mean specificity of 0.84, the small numbers of patients resulted in wide 95% confidence intervals. For distal disease, with only a total of 14 patients studied, the 95% confidence intervals were particularly broad. Although 99mTc-RBC venography is a promising technique, future studies with larger numbers of patients and closer adherence to methodologic standards are required.

Erythrocytes↗

PubMed2005

Assessment of functional capacity of the musculoskeletal system in the context of work, daily living, and sport: a systematic review.

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland-Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.

Activities of Daily Living↗

PubMed2006

The use of urinary dipstick tests to exclude urinary tract infection: a systematic review of the literature.

Several systematic reviews have examined the use of dipstick tests to diagnose or rule in urinary tract infection (UTI). We examined the evidence relating to the use of urine leukocyte esterase and nitrite tests in adults to exclude or rule out UTI. A search of the literature from 1966 to 2003 revealed 30 studies as containing relevant and suitable information and 23 of these, which used a cut-off of 108 colony-forming units per liter, were combined in a meta-analysis. The leukocyte esterase or nitrite test combination, with one or the other test positive, was used in 14 studies, showed the highest sensitivity and the lowest negative likelihood ratio. While there was significant heterogeneity between the studies, 7 of 14 demonstrated significant decreases in pretest to posttest probability with a pooled posttest probability of 5% for the negative result. In certain circumstances, there is evidence for the use of urinalysis as a rule-out test for UTI.

Carboxylic Ester Hydrolases↗

PubMed2005

Are endogenous LH levels during ovarian stimulation for IVF using GnRH analogues associated with the probability of ongoing pregnancy? A systematic review.

The aim of this systematic review was to evaluate, among women with normal ovulation or World Health Organization (WHO) II oligoanovulation who undergo ovarian stimulation for IVF using GnRH analogues, whether endogenous LH levels predict the likelihood of ongoing pregnancy beyond 12 weeks. A literature search identified six studies that answered the research question, among which two were prospective studies (one in GnRH agonist and one in GnRH antagonist cycles). None of the retrospective studies suggest that low endogenous LH levels are associated with a significantly decreased probability of ongoing pregnancy beyond 12 weeks in such patients. In the two prospective studies high endogenous LH levels during down-regulation were associated with a decreased probability of ongoing pregnancy beyond 12 weeks. Until further prospective studies modify the existing evidence summarized here, an adverse effect of low endogenous LH levels on the probability of ongoing pregnancy beyond 12 weeks is not a sensible rationale for LH supplementation during ovarian stimulation for IVF using GnRH analogues.

Female↗

PubMed2006

Reliability of procedures used in the physical examination of non-specific low back pain: a systematic review.

The purpose of this systematic review was to determine the quality of the research and to assess the reliability of different types of physical examination procedures used in the assessment of patients with non-specific low back pain. A search of electronic databases (MEDLINE, PEDro, AMED, EMBASE, Cochrane, and CINAHL) up to August 2005 identified 48 relevant studies which were analysed for quality and reliability. Pre-established criteria were used to judge the quality of the studies and satisfactory reliability, and conclusions emphasised high quality studies (> or = 60% methods score). The mean quality score of the studies was 52% (range 0 to 88%), indicating weak to moderate methodology. Based on the upper threshold used (kappa/ICC > 0.85) most procedures demonstrated either conflicting evidence or moderate to strong evidence of low reliability. When the lower threshold was used (kappa/ICC > 0.70) evidence about pain response to repeated movements changed from contradictory to moderate evidence for high reliability. Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability.

Humans↗

PubMed2003

Pediatric smoking prevention interventions delivered by care providers: a systematic review.

OBJECTIVE: To conduct a systematic review of randomized controlled trials of smoking prevention interventions for youth delivered via medical or dental providers' offices. METHODS: Online bibliographic databases were searched as of July 2002, and reference lists from review articles and the selected articles were also reviewed for potential studies. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study methods, intervention studied, outcomes measured, and results. RESULTS: The literature search returned 81 abstracts from MEDLINE and 49 from Cochrane Clinical Trials Registry (CCTR); of these, four articles met the inclusion criteria. Included were two studies conducted in primary care, and one each in dental and orthodontic offices. Only one study demonstrated a significant effect on smoking initiation; in that study, 5.1% of the intervention group and 7.8% of the control group reported smoking at 12-month follow-up (odds ratio= 0.63; 95% confidence interval, 0.44-0.91). None of the studies had follow-up times greater than 3 years. CONCLUSIONS: There is very limited available evidence demonstrating efficacy of smoking prevention interventions in adolescents conducted in providers' offices and no evidence for long-term effectiveness of such interventions.

Adult↗

PubMed2004

Sudden unexpected death in infancy and socioeconomic status: a systematic review.

This paper aimed to systematically review observational studies documenting the relation between sudden unexpected death in infancy and socioeconomic status. A search of two electronic databases (Medline 1966 to November 2002; Embase 1981 to November 2002) yielded 52 case-control or cohort studies meeting the inclusion criteria. An increased risk of sudden unexpected death in infancy was reported in 51 studies and 32 of 33 studies reporting graded measures of socioeconomic status showed a dose-response relation of sudden death with socioeconomic status. Of the 10 studies in which adjustment was made for maternal smoking, socioeconomic status retained an independent effect on infant death in nine. The effect of socioeconomic status was also independent of birth weight in 10 of 11 studies and independent of sleeping position in two. The included studies reported a significant association of socioeconomic status with sudden unexpected death in infancy with risk of infant death increasing with greater exposure to adverse social circumstances. The findings support a significant role for adverse social circumstances in the pathways to sudden unexpected death in infancy.

Birth Weight↗

PubMed2006

Tetanus vaccination and risk of multiple sclerosis: a systematic review.

OBJECTIVE: To conduct a systematic review on the association between tetanus vaccination and the risk of multiple sclerosis (MS). METHODS: The authors searched the databases Medline, LILACS, EMBASE, and Science Citation Index including the period 1966 to September 1, 2005. Eligible studies had to meet the following inclusion criteria: presentation of original data, case-control or cohort design, physician-confirmed diagnosis of MS as the outcome of interest, attempt to ascertain vaccinations in a period before the diagnosis, and report of an association measure between tetanus vaccination and incidence of MS, and its 95% CI or enough information to compute it. Study specific log ORs were weighted by the inverse of their variances to obtain a pooled estimate and its 95% CI. RESULTS: The OR of MS associated with history of tetanus vaccination was 0.67 (95% CI: 0.55 to 0.81). There was little indication of heterogeneity of results across studies. CONCLUSION: Tetanus vaccination is associated with a lower risk of multiple sclerosis.

Clinical Trials as Topic↗

PubMed2006

Orthodontic anchorage: a systematic review.

The aim of this systematic review was to examine, in an evidence-based way, what kind of orthodontic anchorage systems/applications are evaluated and their effectiveness. A literature survey from the Pub Med and Cochrane databases covering the period from January 1966 to December 2004 was performed. Randomized controlled trials (RCT), prospective and retrospective controlled studies, and clinical trials comparing at least two anchorage situations were included. Two reviewers selected and extracted the data independently and also assessed the quality of the retrieved studies. The search strategy resulted in 494 articles, of which 14 met the inclusion criteria. Two main anchorage situations were identified: anchorage of molars during space closure after premolar extractions and anchorage loss in the incisor or premolar region (or both) during molar distalization. Because of contradictory results and the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate anchorage efficiency during space closure. Intraoral molar distalization leads to anchorage loss in various amounts depending on the choice of distalization unit. Most of the studies had serious problems with small sample size, confounding factors, lack of method error analysis, and no blinding in measurements. To obtain reliable scientific evidence, controlled RCT's with sufficient sample sizes are needed to determine which anchorage system is the most effective in the respective anchorage situation. Further studies should also consider patient acceptance and cost analysis as well as implants as anchorage.

Bicuspid↗

PubMed2003

Leflunomide for the treatment of rheumatoid arthritis: a systematic review and metaanalysis.

OBJECTIVE: To systematically review the evidence from clinical trials on the efficacy and toxicity of leflunomide for the treatment of active rheumatoid arthritis (RA). METHODS: We searched Medline, Embase, Current Contents, and the Cochrane Controlled Trial Register for human randomized controlled trials (RCT) and controlled clinical trials up to December 2001. We also hand-searched reference lists and conference proceedings and consulted content experts. Relative benefit (RB), and weighted mean differences or standardized mean differences with their 95% confidence interval (95% CI) were calculated. RESULTS: Six RCT totaling 2044 patients with RA were included in this review. Using specific criteria, all trials were considered of high methodological quality. Leflunomide improved the ACR20 response rate roughly 2 times over placebo both at 6 months (RB = 1.93, 95% CI 1.51, 2.47) and at 12 months (RB = 1.99, 95% CI 1.42, 2.77). Other clinical outcomes of disease activity and function and radiological scores were also significantly better for leflunomide patients than those taking placebo. No significant differences for most of the outcomes were observed between leflunomide and sulfasalazine (SSZ) or methotrexate (MTX). Adverse events were more common in the leflunomide group, but withdrawal rates were fewer than for placebo. Overall, withdrawal rates and adverse events in the leflunomide group were not different from SSZ or MTX. CONCLUSION: Leflunomide improves all clinical outcomes and delays radiographic progression at 6 and 12 months of RA treatment compared to placebo. Its efficacy and adverse events at 2 years of treatment are comparable to SSZ and MTX. Longterm efficacy and toxicity remain to be established.

Arthritis, Rheumatoid↗

PubMed2005

Reasons for and characteristics associated with complementary and alternative medicine use among adult cancer patients: a systematic review.

PURPOSE: To conduct a systematic review of reasons for and sociodemographic and disease characteristics associated with complementary and alternative medicine (CAM) use in cancer patients. METHODS: Eligible studies were identified by searching the following databases: Alt Health Watch, AMED, CINAHL, CancerLit, PremMEDLINE, MEDLINE, Pub-Med, Ingenta, EMBASE, and Health Star, as well as reference lists in review articles. Only English-language articles published between 1994 and 2004 were included. Search terms included CAM and oncology/cancer, decision making and CAM and oncology/cancer, treatment decision making and CAM and oncology/cancer, and health care choices and CAM and oncology/cancer. RESULTS: Fifty-two eligible studies were identified and summarized. These studies were conducted in 14 different countries, with the largest number of studies being completed in the United States (34.6%). A therapeutic response, wanting control, a strong belief in CAM, CAM as a last resort, and finding hope were the most commonly cited reasons for using CAM. Age, socioeconomic status, and gender were the dominant characteristics associated with CAM use. CONCLUSION: Reasons for and characteristics associated with CAM use among cancer patients have been studied extensively. Future CAM research among cancer patients should focus on identifying decision-making processes and building theoretical decision-making models. These can be used in the development of decisional aids for patients when confronted with the choice to use CAM as part of their cancer treatment.

Adult↗

PubMed2004

Healing of oral lichenoid lesions after replacing amalgam restorations: a systematic review.

OBJECTIVE: We sought to systematically review the literature related to oral lichenoid lesions (OLLs) and amalgam restorations. STUDY DESIGN: Cohort and case-controlled studies (no randomized controlled trials or controlled clinical trials available) were reviewed with respect to inclusion criteria and data on patients with OLLs, treatment interventions, and the measurement of outcomes. RESULTS: Fourteen cohort and 5 case-controlled trials met the criteria. The study population consisted of 1158 patients (27% male and 73% female; age range, 23-79 years). From 16% to 91% of patients had positive patch test results for at least 1 mercury compound. Of 1158 patients, 636 had to have their restorations replaced. The follow-up period ranged from 2 months to 9 1/2 years. Complete healing ranged from 37.5% to 100%. The greatest improvements were seen in lesions in close contact with amalgam. CONCLUSIONS: Protocols must be standardized to obtain valid results. The replacement of amalgam restorations can result in the resolution or improvement of OLLs. Patch testing seems to be of limited value. The topographic relationship between an OLL and an amalgam restoration is a useful--but not conclusive--marker.

Adult↗

PubMed2003

Smoking cessation interventions for adolescents: a systematic review.

OBJECTIVE: To conduct a systematic review of controlled trials for adolescent smoking cessation. METHODS: Online bibliographic databases were searched as of June 2002, and reference lists from review articles and the selected articles were also reviewed for potential studies. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study methods, intervention studied, outcomes measured, and results. RESULTS: The abstracts or full-text articles of 281 relevant studies were examined, of which six met the selection criteria. Included were three school-based studies, a study in pregnant adolescent girls, a hospital-based study, and a trial of laser acupuncture. All three of the school-based studies reported significant impacts on cessation rates, although only one of these was a randomized trial. None of the studies had follow-up times of >5.2 months. CONCLUSIONS: There is very limited evidence demonstrating efficacy of smoking-cessation interventions in adolescents, and no evidence on the long-term effectiveness of such interventions. Smoking-cessation interventions that have proven most effective in adults, such as nicotine replacement and antidepressant use, have not been studied in adolescents in a controlled manner.

Adolescent↗

PubMed2000

Does physical activity prevent weight gain--a systematic review.

This paper is a systematic review of research data on associations between physical activity and weight gain, with or without prior weight reduction. The selected studies were restricted to Caucasian (white) adults. Most studies with data on physical activity collected at follow-up, found an inverse association between physical activity and long-term weight gain. This finding was present in studies both with and without prior weight reduction. Prospective studies with physical activity measured at baseline, and randomized weight reduction interventions, gave inconsistent results regarding the effects of increased physical activity on weight change. The weighted mean weight regain in randomized studies with or without exercise training was 0.28 and 0.33 kg/month, respectively. Based on observational studies, it seemed that an actual increase in energy expenditure of physical activity of approximately 6300-8400 kJ/week (1500-2000 kcal/week) is associated with improved weight maintenance. This is more than was prescribed in most randomized trials, and certainly more than the participants actually achieved. Adherence to a prescribed exercise programme remains a big challenge. Before new methods to improve exercise adherence are found, the role of prescribed physical activity in prevention of weight gain remains modest.

Adult↗

PubMed1999

Cervical length and dilatation of the internal cervical os detected by vaginal ultrasonography as markers for preterm delivery: A systematic review.

OBJECTIVE: We performed a systematic review to evaluate endovaginal cervical ultrasonography as a predictor of preterm delivery. STUDY DESIGN: Selection criteria were original published English-language reports of prospective studies including women at <37 weeks' gestation with intact amniotic membranes. Parameters and outcomes were cervical length or dilatation of the internal cervical os and preterm delivery. RESULTS: In 3 subgroups of studies including patients with preterm labor or low-risk, symptom-free patients with early (20-24 weeks) or late (27-32 weeks) ultrasonographic examination, optimal cutoff values for cervical lengths ranged between 18 and 30, 25 and 35, or 25 and 39 mm. At these cutoff values, sensitivity rates were between 68% and 100%, 33% and 54%, or 63% and 76%, and specificity rates were between 44% and 79%, 73% and 91%, or 59% and 69%, respectively. Sensitivity rates for dilatation of the internal cervical os were 70% to 100%, 16% to 25%, or 33%, and specificity rates were 54% to 75%, 95% to 99%, or 92%, respectively. CONCLUSION: In patients with symptoms of preterm labor, endovaginal cervical ultrasonography appears to be an effective predictor of preterm delivery.

Cervix Uteri↗

PubMedDate not supplied

Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review.

The authors conducted a systematic review to assess the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of calcific and noncalcific tendonitis of the rotator cuff. Conservative treatment for rotator cuff tendonitis includes physiotherapy, nonsteroidal antiinflammatory drugs, and corticosteroid injections. If symptoms persist with conservative treatment, surgery is often considered. Extracorporeal shock wave therapy has been suggested as a treatment alternative for chronic rotator cuff tendonitis, which may decrease the need for surgery. Articles for this review were identified by electronically searching Medline, EMBASE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), and Evidence Based Medicine (EBM) and hand-screening references. Two reviewers selected the trials that met the inclusion criteria, extracted the data, and assessed the methodological quality of the selected trials. Finally, the strength of scientific evidence was appraised. Evidence was classified as strong, moderate, limited, or conflicting. Sixteen trials met the inclusion criteria. There were only five randomized, controlled trials and all involved chronic (>/=3 months) conditions, three for calcific tendonitis and two for noncalcific tendonitis. For randomized, controlled trials, two (40%) were of high quality, one (33%) for calcific tendonitis and one (50%) for noncalcific tendonitis. The 11 nonrandomized trials included nine that involved calcific tendonitis and two that involved both calcific and noncalcific tendonitis. Common problem areas were sample size, randomization, blinding, treatment provider bias, and outcome measures. There is moderate evidence that high-energy ESWT is effective in treating chronic calcific rotator cuff tendonitis when the shock waves are focused at the calcified deposit. There is moderate evidence that low-energy ESWT is not effective for treating chronic noncalcific rotator cuff tendonitis, although this conclusion is based on only one high-quality study, which was underpowered. High-quality randomized, controlled trials are needed with larger sample sizes, better randomization and blinding, and better outcome measures.

Calcinosis↗

PubMed2004

New technologies in screening for breast cancer: a systematic review of their accuracy.

We systematically reviewed the literature on the accuracy of new technologies proposed for breast cancer screening. Four potential tests were identified (ultrasound, magnetic resonance imaging (MRI), full-field digital mammography (FFDM), and computer-aided detection (CAD)) for which primary studies met quality and applicability criteria and provided adequate data on test accuracy. These technologies have been assessed in cross-sectional studies of test accuracy where the new test is compared to mammography. Ultrasound, used as an adjunct to mammography in women with radiologically dense breasts, detects additional cancers and causes additional false positives. Magnetic resonance imaging may have a better sensitivity (but lower specificity) than mammography in selected high-risk women, but studies of this technology included small number of cancers. Computer-aided detection may enhance the sensitivity of mammography and warrants further evaluation in large prospective trials. One study of FFDM suggests that it may identify some cancers not identified on conventional mammography and may result in a lower recall rate. The evidence is currently insufficient to support the use of any of these new technologies in population screening, but would support further evaluation.

Breast Neoplasms↗