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PubMed1986

The effect of waiting for inpatient alcoholism treatment after detoxification. An experimental comparison between inpatient treatment and advice only.

Seventeen detoxified alcoholics were randomly assigned to a waiting list group or an inpatient treatment group. The waiting list group members were informed that they had to wait some time until there was a vacant place. By their discharge from the Detoxification Unit they were told to complete a self-report form every day with regards to drinking, working, sleeping home and use of disulfiram orally. Two weeks later they had an outpatient appointment in which the self-reports were collected and reviewed. This was repeated once for everybody so that they all had to wait 4 weeks. By discharge from further inpatient treatment, the inpatient treatment group was instructed to record the same four behaviors daily as the waiting list group did, and they, too, got an outpatient appointment with a 2 week interval. No significant differences between the groups were observed in the three main variables of drinking, working and sleeping home, but the waiting list group used significantly more disulfiram than the inpatient treatment group.

Adult↗

PubMed2005

Is thrombolytic therapy associated with increased mortality? Meta-analysis of randomized controlled trials.

BACKGROUND: Although thrombolytic therapy has shown substantial benefits in neural outcomes, concerns remain regarding the association between thrombolytic therapy and possible increased mortality. OBJECTIVE: To determine the mortality risk of certain thrombolytic agents that are a treatment option for acute ischemic stroke. DATA SOURCES, EXTRACTION, AND SYNTHESIS: Studies were identified using MEDLINE, the Cochrane Central Register of Controlled Trials, and the reference lists of the articles selected. Randomized placebo-controlled trials of thrombolytic agents for the treatment of acute ischemic stroke patients were eligible. Study quality was evaluated using a previously validated scale. Data were extracted in duplicate by two independent investigators. All-cause mortality during follow-up was the main outcome. Random effects models were used to pool the individual effects of trials. Several preplanned sensitivity and subgroup analyses were completed to explain the heterogeneity among trials. Odds ratios, absolute risk differences, and numbers needed to harm were calculated. RESULTS: Eleven placebo-controlled randomized trials of thrombolytic agents involving 3709 participants were included in the analysis. Thrombolytic therapy was associated with an insignificant increase in mortality (odds ratio, 1.07; 95% confidence interval, 0.8-1.39; P = .3). The treatment was associated with an absolute increased risk of mortality of 11 per 1000 persons (95% confidence interval, -24 to 48; P = .3), and the number needed to harm was 84 (the 95% confidence interval included 0). CONCLUSION: These findings suggest that thrombolytic therapy does not significantly increase all-cause mortality.

Brain Ischemia↗

PubMed2001

[Health status of patients on waiting lists].

BACKGROUND: The waiting lists for hospital admission are used as arguments for more resources to hospitals. Concern is expressed that the attention given to waiting list patients has the effect that less resources are devoted to other groups of patients. This article reports on a study of whether waiting list patients are in poorer health that persons who are not on a waiting list. MATERIAL AND METHODS: A random sample of 5,000 Norwegian citizens were drawn to be included in Statistics Norway's 1998 quality and standard of life survey. Interviews were obtained with 3,449 persons. Binomial and multinomial logistic analyses were used. RESULTS: Individuals in poor health have a higher probability of being on a hospital waiting list than have persons in good health. We did not find any relationship between state of health and a patient's experienced waiting time. INTERPRETATION: Our findings reject the assertion of arbitrariness regarding the selection of patients to hospital waiting lists. The lack of effect of state of health on experienced waiting time could be interpreted in several ways.

Adult↗

PubMed2000

Exercise therapy for low back pain: a systematic review within the framework of the cochrane collaboration back review group.

STUDY DESIGN: A systematic review of randomized controlled trials was performed. SUMMARY OF BACKGROUND DATA: Exercise therapy is a widely used treatment for low back pain. OBJECTIVES: To evaluate the effectiveness of exercise therapy for low back pain with regard to pain intensity, functional status, overall improvement, and return to work. METHODS: The Cochrane Controlled Trials Register, Medline, Embase, PsycLIT, and reference lists of articles were searched. Randomized trials testing all types of exercise therapy for subjects with nonspecific low back pain with or without radiation into the legs were included. Two reviewers independently extracted data and assessed trial quality. Because trials were considered heterogeneous with regard to study populations, interventions, and outcomes, it was decided not to perform a meta-analysis, but to summarize the results using a rating system of four levels of evidence: strong, moderate, limited, or none. RESULTS: In this review, 39 trials were identified. There is strong evidence that exercise therapy is not more effective for acute low back pain than inactive or other active treatments with which it has been compared. There is conflicting evidence on the effectiveness of exercise therapy compared with inactive treatments for chronic low back pain. Exercise therapy was more effective than usual care by the general practitioner and just as effective as conventional physiotherapy for chronic low back pain. CONCLUSIONS: The evidence summarized in this systematic review does not indicate that specific exercises are effective for the treatment of acute low back pain. Exercises may be helpful for patients with chronic low back pain to increase return to normal daily activities and work.

Exercise Therapy↗

PubMed1997

Persistence of atopic effects on airway calibre and bronchial responsiveness in older adults.

BACKGROUND: the relationships between atopy and chronic airflow obstruction and bronchial hyperresponsiveness in adults are unclear. We measured airways calibre (FEV1), bronchial responsiveness, eosinophil count and total serum IgE in a random population sample of adults aged 45 years or older. METHODS: Caucasian adults (n = 783) were selected from the practice lists of local general practitioners using random number tables. Responders to a postal questionnaire were invited to attend for venous blood sampling and methacholine challenge (Newcastle dosimeter method). FINDINGS: the questionnaire response rate was 92.3% (723 subjects); 62.5% of subjects invited to attend did so. Attenders were slightly younger than the whole study population, but otherwise representative. Methacholine challenge was completed by 208 subjects. Geometric mean IgE level was higher in current smokers; both IgE and eosinophils were raised in subjects reporting asthma. Multiple regression showed a negative independent relationship between age- and sex-standardized eosinophils and baseline FEV1 and a positive relationship between standardized IgE score and level of bronchial responsiveness. Separate analysis of subjects aged <65 and > or =65 years showed that these relationships were only significant in older subjects. INTERPRETATION: airways calibre and level of bronchial responsiveness are associated with measures of atopy in older adults. Atopy should not be overlooked as a factor in elderly patients with asthma or chronic airflow obstruction.

Age Factors↗

PubMed1995

Heartsink patients: a study of their general practitioners.

BACKGROUND: A number of attempts have been made to investigate the heartsink, difficult, dysphoric or problem patient. Most studies have emphasized the role which the patient plays in evoking despair, anger and frustration in the doctor. However, one doctor's list of difficult patients may not necessarily be the same as another's. AIM: A study was undertaken to determine if the individual characteristics of general practitioners are associated with the number of heartsink patients they report on their patient lists. METHOD: Sixty out of 137 urban general practitioners drawn at random from the Sheffield Family Health Services Authority list were surveyed by structured interview and questionnaires in 1990. Outcome measures were interview data and scores on the 12-item general health questionnaire, Warr-Cook-Wall job satisfaction scale and the Bortner personality profile measure. RESULTS: Sixty per cent of the variance in the number of heartsink patients that general practitioners reported on their lists could be accounted for by the following four explanatory variables: greater perceived workload; lower job satisfaction; lack of training in counselling and/or communication skills; and lack of appropriate postgraduate qualifications. No other variables considered could account for the variance in the number of heartsink patients reported by general practitioners. CONCLUSION: The individual characteristics of doctors are associated with the number of heartsink patients reported by general practitioners. To reduce the number of such patients experienced, it may be necessary for general practitioners to reduce their workload and increase their job satisfaction and their level of relevant postgraduate training.

Attitude of Health Personnel↗

PubMed2001

Conservative treatment for whiplash.

BACKGROUND: Many treatments are available for whiplash-patients, but to date, no evidence exists for their effectiveness. OBJECTIVES: The objective of this systematic review was to assess the efficacy of conservative treatment in patients with whiplash-injuries (rated as Whiplash-Associated Disorders [WAD] I or II). SEARCH STRATEGY: A computerized literature search of Medline, Embase, Cinahl, Psychlit and the Cochrane Controlled Trial Register through June 1998 was carried out. We also screened reference lists of publications of identified randomized trials and relevant systematic reviews. SELECTION CRITERIA: Studies were selected for inclusion if they fit the following criteria: design was a (randomized) clinical trial (RCT); all patients had suffered a whiplash-injury; the type of intervention was a conservative one; pain, global perceived effect, or participation in daily activities was used as one of the outcome measures; and the publication was written in English, French, German or Dutch. DATA COLLECTION AND ANALYSIS: The methodological quality of the studies was independently assessed by two reviewers using the Maastricht-Amsterdam list. Three quality scores were calculated using this criteria list: the Overall methodological Quality Score, the Internal Validity Score and the Delphi Quality Score. The conclusion of the review was based on articles that scored a quality score of at least 50 percent of the maximum available score on two out of three quality scores. MAIN RESULTS: Eleven studies met the inclusion criteria. A broad variety of conservative interventions were evaluated, and only one study was performed in chronic whiplash patients. Only three studies satisfied at least 50 percent on two out of three quality scores indicating poor overall methodological quality. A high rank correlation was observed among the three methods of quality. Because of the heterogeneity of patient selection, interventions and outcome measures, no statistical pooling was performed. This review indicates that active treatments show a beneficial effect on at least one of the primary outcome measures, preferably pain. REVIEWER'S CONCLUSIONS: It appears that "Rest makes rusty." In other words, rest and immobilization using collars are not recommended for the treatment of whiplash, while active interventions, such as advice to 'maintain usual activities' might be effective in whiplash-patients. Nevertheless, caution is needed when attempting to draw conclusions regarding the efficacy of conservative treatments in whiplash-patients, because of the paucity of high-quality studies. No conclusions can be drawn about the most effective therapy for chronic whiplash-patients because only one low quality trial was identified.

Activities of Daily Living↗

PubMed2001

Event history calendars and question list surveys: a direct comparison of interviewing methods.

The research reported in this article provides the first direct experimental comparison between Event History Calendar (EHC; N=309; 84.4 percent response rate) and standardized state-of-the-art question list (Q-list; N=307; 84.1 percent response rate) interviewing methodologies. Respondents and 20 interviewers were randomly assigned to EHC and Q-list interviews that were conducted via telephone in the spring of 1998. All interviews asked for retrospective reports on social and economic behaviors that occurred during the calendar years of 1996 and 1997. Using data from the same respondents collected 1 year earlier on events reported during 1996 as a standard of comparison, the quality of retrospective reports on 1996 events from the 1998 administration of EHC and Q-list interviews was assessed. In comparison to the Q-list, the EHC condition led to better-quality retrospective reports on moves, income, weeks unemployed, and weeks missing work resulting from self illness, the illness of another, or missing work for these reasons in combination with other ones. For reports of household members entering the residence, and number of jobs, the EHC led to significantly more overreporting than the Q-list. Contingent on additional research that examines a wider range of reference periods and different modes of interviewing, the EHC may become a viable and potentially superior method to the Q-list in the collection of self-reported retrospective information.

Journal Article↗

PubMed2002

Vaginal estrogen preparations: a review of safety and efficacy for vaginal atrophy.

BACKGROUND: A theoretical advantage of local (i.e., vaginal) therapy of genitourinary symptoms could be avoidance of systemic adverse effects. Review of efficacy and adverse effects of commonly prescribed vaginal estrogens is of great clinical relevance. METHODS: A Medline (1966-present) search was performed for randomized controlled trials involving vaginal estrogens. Reference lists of papers were reviewed for additional references. RESULTS: Twenty-two references were randomized controlled trials of vaginal estrogens used by postmenopausal women with signs or symptoms of vaginal atrophy. Subject numbers ranged from 20 to 251. Duration ranged from 2 weeks to 1 year. Different preparations and schedules were used across the trials. All treatments alleviated signs and symptoms of atrophic vaginitis, regardless of whether objective signs of atrophy were required for study entry. Data for urinary symptoms was conflicting; the ring may prevent recurrent urinary tract infections (UTIs). The trials with endometrial scrutiny were less than one year and had mixed results. Nonhormonal lubricant is effective in improving some atrophic signs and symptoms. All preparations were associated with vaginal irritation. Bleeding with vaginal estradiol tablets may be less than that with CEE cream. Vaginal tablets or rings were preferred over other preparations. There were no serious adverse events reported. There was occasional expulsion of estradiol ring in the setting of prior hysterectomy. CONCLUSIONS: All preparations are effective in decreasing signs and symptoms of vaginal atrophy, but they differ slightly in their adverse event profiles. Long-term safety of the preparations is best established for estradiol tablets (1 year), but is lacking for all preparations.

Administration, Intravaginal↗

PubMed2003

Evaluation of an individualised asthma programme directed at behavioural change.

An individualised asthma programme directed at behavioural change was evaluated in asthmatic subjects who reported complaints and impairment, despite adequate medical treatment. Mild-to-moderate asthma patients (n=23) were randomly assigned to a programme or waiting list condition. Outcome measures were: McMaster Asthma Quality of Life Questionnaire, Asthma Symptom Checklist, Negative Emotionality Scale, Knowledge, Attitude and Self-Efficacy Asthma Questionnaire, Adherence Scale, and peak flow measurements. Both groups were evaluated at three consecutive moments, each separated by 3 months; the programme was delivered between the first two evaluations. At onset the patient received a workbook containing information, exercises and homework assignments. Psycho-education, behavioural and cognitive techniques were introduced during six 1-h individual sessions. Compared with controls the programme group reported less symptoms (obstruction, fatigue), better quality of life (activity, symptoms, emotions), decreased negative affectivity, and increased adherence, immediately after finishing the programme and at 3 months follow-up. All three cognitive variables (knowledge, attitude towards asthma, self-efficacy) and day and night peak flow ratings improved in the programme group but not in the waiting list group. Participation in an individualised programme resulted in improvement of asthma morbidity, and asthma-related behaviour and cognitions, in subjects reporting symptoms and impairment despite adequate medical therapy.

Adult↗

PubMed1993

[An epidemiological study of allergic conjunctivitis].

An epidemiological study focusing on the home environment and lifestyle was conducted in order to analyze the differences between a group of patients with allergic conjunctivitis only and a group with other allergic diseases associated with allergic conjunctivitis. Subjects were five hundred and sixty-four patients who visited the Ophthalmologic Clinic of Tokai University Hospital during 1990, and for controls 200 households were randomly selected from an elementary school list in Yokohama city. RAST score was measured in 102 patients. A mailed questionnaire was sent to 240 patients chosen at random and to 200 controls. Sixty patients and 139 controls responded to the questionnaire. RAST score showed no statistical difference between patients with allergic conjunctivitis only and patients with other allergic diseases associated with allergic conjunctivitis. Analysis of associations between RAST score and seasonal symptoms, showed very strong positive reactions to pollens in patients with seasonal symptoms. On the other hand, in patients with constant symptoms during the year, reaction was very strong to house dust and mite. Epidemiological factors causally associated with allergic conjunctivitis were compared among the controls, patients with allergic conjunctivitis only (Group I), patients with other allergic diseases (Group II) and all patients (Group III). Compared to controls, Groups II and III had significantly higher prevalence of past history of skin itching and inflammatory symptoms (p < 0.05 and p < 0.01, respectively). Group II subjects showed more frequent use of carpets, when compared to the controls (p < 0.05). The use of Japanese mattress (futon) was more frequent in Group II and III than controls (p < 0.05 for both comparisons).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1980

Can helping hurt? Effects of constraining and nonconstraining retrieval cue on list transfer by mentally retarded adolescents.

Retarded adolescents were given constraining and nonconstraining retrieval cues on one of the four presentation and recall trials. Subjects were cued on either Trials 2 or 3, and one-half of each group received either blocked or random presentation over the first two trails. Lists for the last two trials were randomly arranged. On Trial 4, recall for all subjects was uncued. Subjects who received nonconstraining cues showed significantly more recall transfer than did those in the constraining condition; there were no significant differences on Trials 1 through 3. Blocking facilitated clustering but not recall. Improvement over trials was associated with increases in both the number of categories and the mean number of words per category recalled. Results suggested that the provision of constraining retrieval cues may have encouraged subjects to adopt a passive role in list learning, a tendency that proved to be detrimental to subsequent uncued list processing.

Adolescent↗

PubMed2006

Habit reversal as a treatment for chronic skin picking: a pilot investigation.

The purpose of this study was to compare the effectiveness of habit reversal (HR) to a wait-list control as a treatment for chronic skin picking in adults. Twenty-five adults with a chronic skin-picking problem were randomly assigned to a wait-list control or HR group. At pretreatment, posttreatment, and a 3-month follow-up, self-reported skin picking was assessed, and photographs were taken of the damaged areas and later rated by independent observers. Treatment acceptability data were collected at posttreatment only. Results showed that HR produced a greater decrease in skin picking at posttreatment and follow-up when compared to the wait-list control group. Data from the independent raters confirmed these findings. HR was also viewed as an acceptable intervention by the participants.

Adolescent↗

PubMed2006

Neurocognitive outcomes in off-pump versus on-pump bypass surgery: a randomized controlled trial.

BACKGROUND: Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass. However, the cognitive benefit of off-pump surgery remains unclear. METHODS: Consecutively listed candidates for elective bypass were randomly assigned to either off-pump or on-pump techniques (n = 107). A battery of 11 standardized neuropsychological tests was administered before surgery, and again at 2 and 6 months after surgery. The two groups were compared using a range of statistical procedures, including growth modeling. RESULTS: There were no significant differences in cognitive test scores between the off-pump and on-pump groups using t tests at any of the time points. There were no differences between off-pump and on-pump groups in the incidence of cognitive deficits at 2 months or 6 months, with the exception that fewer off-pump patients showed impairment on one test of verbal fluency at 6 months. When the pattern of cognitive change over time between the two groups was compared using sophisticated modeling techniques, the two groups were again comparable, except for results on the test of verbal fluency, in which the off-pump group showed more rapid postsurgical cognitive gains than the on-pump group. CONCLUSIONS: The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes.

Aged↗

PubMed2006

Continuous versus cyclic use of combined oral contraceptives for contraception: systematic Cochrane review of randomized controlled trials.

BACKGROUND: With the recent US Food and Drug Administration approval of a combination oral contraceptive that causes a withdrawal bleed every 3 months instead of monthly, avoidance of menstruation through extended or continuous administration (>28 days of active pills) of combined oral contraceptives may become more commonplace for reasons of personal preference rather than limited to treatment of menstrual-associated medical disorders. METHODS: The review aimed to compare contraceptive efficacy, compliance, continuation, satisfaction, bleeding profiles, and menstrual symptoms of combined oral contraceptives with continuous dosing (>28 days of active pills) versus traditional cyclic dosing (21 days of active pills and 7 days of placebo). We searched five computerized databases as well as reference lists of relevant articles for randomized controlled trials (RCT) using continuous or extended combined oral contraceptives for contraception. Two reviewers independently extracted data from eligible articles. RESULTS: Six RCT met inclusion criteria and were of good quality. Contraceptive efficacy and compliance were similar between groups. Discontinuation overall, and for bleeding problems, was not uniformly higher in either group. When studied, participants reported high satisfaction with both dosing regimens. Five out of the six studies found that bleeding patterns were either equivalent or improved with continuous-dosing regimens. The continuous-dosing group had greater improvement of menstrual-associated symptoms (headaches, genital irritation, tiredness, bloating, and menstrual pain). CONCLUSIONS: The variations in pill type and time-interval for continuous dosing make direct comparisons between regimens unfeasible. To allow for comparisons, future studies should choose a previously researched pill and dosing regimen. More attention needs to be directed towards participant satisfaction and menstruation-associated symptoms.

Adult↗

PubMed2002

Effect of hyaluronidase on ocular motility in sub-Tenon's anesthesia: randomized controlled trial.

PURPOSE: To assess the effect of hyaluronidase additive on the onset and degree of ocular akinesia in sub-Tenon's anesthesia for cataract surgery. SETTING: Routine cataract operating list. METHOD: This double-blind randomized controlled study comprised 100 patients who had phacoemulsification cataract surgery. Patients were randomized to 1 of 2 groups. For sub-Tenon's anesthesia, Group A received 5 mL lignocaine 2% with sodium hyaluronidase 150 IU/mL and Group B, 5 mL plain lignocaine 2%. Akinesia was assessed by scoring movement in the 6 positions of gaze. Scores ranged from 0 (complete akinesia) to 3 (no akinesia). Movements were measured at 30 seconds and 1, 3, 5, and 10 minutes. Changes in motility scores were compared by the Mann-Whitney U test. RESULTS: There was no significant difference in akinesia between the 2 groups 30 seconds after the injection (P =.224); however, at 1 and 3 minutes, Group A achieved significantly better akinesia than Group B (P =.003 and P =.023, respectively). The median score after 3 minutes was 3.5 (interquartile range 0 to 7.5) in Group A and 7.0 (interquartile range 2.5 to 10.0) in Group B. There was no significant difference between the groups at 5 and 10 minutes (P =.225 and P =.831, respectively). CONCLUSIONS: The addition of hyaluronidase in sub-Tenon's anesthesia significantly improved the rapidity of the onset of akinesia. This benefit disappeared over time; after 5 minutes the akinesia observed in the group receiving hyaluronidase was similar to that in the group receiving lignocaine alone. Thus, there appears to be no benefit to adding hyaluronidase to the anesthetic solution in terms of final ocular akinesia.

Aged↗

PubMed2003

Antioxidant vitamins and mortality in older persons: findings from the nutrition add-on study to the Medical Research Council Trial of Assessment and Management of Older People in the Community.

BACKGROUND: Older persons are at risk of both poor nutrition and increased oxidative stress. Plasma ascorbate concentrations fall with increasing age, and concentrations of other antioxidants may also be reduced. OBJECTIVE: The goal was to examine the association between antioxidants and mortality in older persons. DESIGN: We randomly selected persons aged 75-84 y from the lists of 51 British family practitioners taking part in a randomized trial of assessment of older persons. A total of 1214 participants provided a blood sample and were interviewed about their usual diet with the use of a food-frequency questionnaire. Statistical analyses were based on deaths after a median of 4.4 y of follow-up, and hazard ratios were estimated for quintiles of dietary or blood antioxidants. RESULTS: We found strong inverse trends for blood ascorbate concentrations with all-cause and cardiovascular disease mortality, which were only marginally reduced after adjustment for confounders or supplement use. Those in the lowest fifth (< 17 micromol/L) had the highest mortality, whereas those in the highest fifth (> 66 micromol/L) had a mortality risk nearly half that (hazard ratio = 0.54; 95% CI: 0.34, 0.84). Similar results were found after the exclusion of those subjects with cardiovascular disease or cancer at baseline (hazard ratio = 0.51; 0.28, 0.93). In fully adjusted models, there was no evidence for an influence of alpha-tocopherol, beta-carotene, or retinol on total mortality. Dietary antioxidants measured by the food-frequency questionnaire were not associated with all-cause or cardiovascular disease mortality. CONCLUSION: Low blood vitamin C concentrations in the older British population are strongly predictive of mortality.

Aged↗

PubMed2003

Brief psychoeducational parenting program: an evaluation and 1-year follow-up.

OBJECTIVE: Despite recognition of the need for parenting interventions to prevent childhood behavioral problems, few community programs have been evaluated. This report describes the randomized controlled evaluation of a four-session psychoeducational group for parents of preschoolers with behavior problems, delivered in community agencies. METHOD: In 1998, 222 primary caregivers, recruited through community ads, filled out questionnaires on parenting practices and child behavior. Parents were randomly assigned to immediate intervention or a wait-list control. The intervention comprised three weekly group sessions and a 1-month booster, the focus being to support effective discipline (using the video 1-2-3 Magic) and to reduce parent-child conflict. RESULTS: Using an intent-to-treat analysis, repeated-measures analyses of variance indicated that the parents who received the intervention reported significantly greater improvement in parenting practices and a significantly greater reduction in child problem behavior than the control group. The gains in positive parenting behaviors were maintained at 1-year follow-up in a subset of the experimental group. CONCLUSIONS: This brief intervention program may be a useful first intervention for parents of young children with behavior problems, as it seems both acceptable and reasonably effective.

Adult↗