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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 613 records · Page 34Linked to original sources
PubMed2002

Methods of meta-analysis: an analysis.

PURPOSE OF REVIEW: To understand the principles of systematic reviewing and meta-analysis, using recent examples from the medical literature to highlight some of these points. RECENT FINDINGS: The word 'meta-analysis' is an intimidating one, and its associated jargon makes it seem incomprehensible. Actually, it is only a mathematical maneuver to add up data in a systematic review; it might be better called 'meta-addition'. The systematic review is a process of using the best available evidence to answer a particular clinical question. Data combination (usually done with meta-analysis) increases the power to see small differences and makes a more precise estimate of a treatment effect. Its major drawback is heterogeneity (the proverbial problem of adding apples and oranges). Systematic reviews have been used by medical societies to create position statements. Such statements have suggested that parenteral nutrition is far less efficacious than previously believed. Systematic reviews in some areas of nutritional support have clarified type II errors. Problems exist, however, in a number of the published meta-analyses of aspects of this therapy. SUMMARY: Especially in an era of resource restraint, we need to become more skilled at interpreting evidence from clinical research.

Clinical Trials as Topic↗
PubMedDate not supplied

Heart failure management in a community hospital system.

Chronic disease management requires a clear vision, collaboration, and continuing program development to be successful. The patient benefits from an approach that is patient-centered and goal directed. Our challenge in this environment of declining healthcare reimbursement is to stay the course and continue measurement of our outcomes to determine our success in meeting our goals.

Aftercare↗
PubMed2005

Teaching the patient with a chronic wound.

PURPOSE: To provide the physician and registered professional nurse with an overview of education strategies for patients with wounds. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in learning more about strategies for educating patients with wounds. OBJECTIVES: After reading the article and taking the test, the participant should be able to: 1. Describe the educational needs of the adult learner. 2. Discuss strategies for educating the adult learner in wound care.

Adult↗
PubMedDate not supplied

Health literacy: implications for teaching the adult patient.

Health literacy--the "ability to read, understand and use health information to make appropriate healthcare decisions"--was brought to national attention in April 2004 when the Institute of Medicine and the Agency for Healthcare Quality and Research published reports linking low health literacy with negative patient outcomes. Harvey Fineberg commented in the Institute of Medicine report, "Health Literacy, a Prescription to End Confusion": "Health literacy, enabling patients to understand and to act in their own interest remains a neglected final path to high quality healthcare." This article defines health literacy, describes the scope of the problem, identifies affected patient groups, and offers interventions to maximize patient understanding during the teaching process.

Adult↗
PubMed2006

Quality of reporting of orthopaedic diagnostic accuracy studies is suboptimal.

Complete and accurate reporting of diagnostic research are essential to assess the validity of its results. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting of Diagnostic Accuracy (STARD) steering committee has developed a checklist of 25 items. We asked whether the quality of reporting of diagnostic accuracy studies published in three major orthopaedic journals (Clinical Orthopaedics and Related Research, Journal of Bone and Joint Surgery British Volume, and Journal of Bone and Joint Surgery American Volume) would be similar across levels of study, journals, and years of publication, and would be similar to other subspecialty journals. We identified 37 articles from 2002-2004 diagnostic accuracy studies and applied the STARD checklist and scoring system. The scores ranged from 6.6 to 21.4 with a mean of 15 +/- 3.3. Only 38% of the articles (14 of 37) reported more than 2/3 of the items, and the majority failed to report nine specific items. The mean STARD scores were similar between the studies with different levels of evidence, across the three journals, and across the three years of publication. They were similar to scores for other subspecialty journals. The current standards of reporting of diagnostic accuracy studies in orthopaedic journals are suboptimal.

Diagnostic Techniques and Procedures↗
PubMed1995

Preparatory information for myelogram.

This study identified preparatory information appropriate for patients undergoing myelogram. Twenty-eight patients (16 lumbar and 12 cervical) described the sensations they experienced as they were having a myelogram. Sensations reported by 40% or more of the participants having both kinds of myelograms included hard, cold examining table; wet and cold cleansing of site; stick with injection of local anesthetic; sharp stick with spinal needle insertion; and burning (cervical) or sharp, tingling (lumbar) with contrast medium injection. These sensations, linked with the temporal elements of the procedure, yield a preparatory information intervention appropriate for those scheduled for myelogram. When preparatory information is used for the same myelogram procedure as described in this study, patients should experience reduced anxiety before and during the procedure.

Adult↗
PubMed2006

Practice development 'without walls' and the quandary of corporate practice.

AIM: The context of this study is a group of clinical nurse specialists from across a Trust seeking accreditation as a practice development unit. The university was asked to facilitate the accreditation process via 11 2-hour learning sessions (including a one-hour focus group). During initial discussions between the university and practice development unit, the overarching research question for this study was set as: 'what are the main roles and responsibilities of clinical nurse specialists?' BACKGROUND: Although there is no known study of a practice development unit based beyond a ward or speciality, the central tenet of the practice development unit literature is that units must demonstrate their worth if they are to survive and harness senior management support in doing so. DESIGN AND METHODS: Data gleaned from the transcribed audio tape-recordings of the learning sessions were studied at least three times to ensure transcription accuracy and produce detailed charts. Ethical approval was granted by the appropriate Local Research Ethics Committee and written informed consent obtained from clinical nurse specialists. The study lasted 30 months and ended in October 2004. RESULTS: The four crucial statements that give meaning to specialist practice are: quality care giver; expert; information giver and initiator of change. Further analysis reveals the area of corporate and political practice as being missing from this and other lists of clinical nurse specialist attributes found in the literature. Clinical nurse specialists characterize their relationship with the Trust in terms of dichotomy--differing agendas and perceptions of value. CONCLUSIONS: The specialist role requires professional development in the areas of corporate and political acumen and professional business management. While the findings of this study relate to one Trust and a group of 16 clinical nurse specialists, with careful application they may be transferable to other settings and groups of senior nurses.

Accreditation↗
PubMed1996

The future of clinical research: from megatrials towards methodological rigour and representative sampling.

A powerful impetus behind the rise of the 'megatrial' (a large, simple, usually multi-centred randomized controlled trial analysed by 'intention to treat') has been the desire for ever-increasing precision in the measurement of therapeutic effectiveness. However, the demand for precision has been allowed to override other and more important methodological considerations. Megatrials have progressively abandoned the pursuit of scientifically rigorous experimentation, valid measurement and optimal epidemiological sampling in favour of recruiting and processing large number of subjects. This is a mistaken strategy which leads inevitably to error, because investigators are seeking a primarily statistical, rather than clinically or scientifically relevant, notion of exactness. We are now in a position to describe a clinical research strategy which offers many advantages over a megatrial-led approach. Research should be planned with an awareness that the validity and applicability of estimated is more important that their numerical precision, and that this requires both and unselected denominator population database of all incident cases, and maximally controlled randomized trials and other studies. The Population-Adjusted Clinical Epidemiology (PACE) strategy is suggested as exemplifying the twin principles of clinically useful research: rigorous science and representative epidemiology.

Confidence Intervals↗
PubMed2006

Research results have expiration dates: ensuring timely systematic reviews.

Time and timeliness are key issues in appraising and ensuring the clinical relevance of systematic reviews. Time considerations entering the systematic review process include the history of the clinical problem, disease, or treatment that is the target of the review, and the history of the research conducted to address it. These considerations guide: (i) formulation of the research problems and questions; (ii) setting of parameters for the search and retrieval of studies; (iii) determination of inclusion and exclusion criteria; (iv) appraisal of the clinical relevance of findings; (v) selection of the findings that will be synthesized; and (vi) interpretation of the results of that synthesis.

Humans↗